Post-Appendectomy Intra-Abdominal Abscess in Children with Perforated Appendicitis: A Narrative Review

Abstract

Post-appendectomy intra-abdominal abscess (PAA) is a common and problematic complication in children with perforated appendicitis, contributing to prolonged hospitalization, readmissions, and increased healthcare costs. Despite advances in surgical and antimicrobial management, substantial heterogeneity persists in definitions, risk stratification, and treatment strategies. This narrative review aims to synthesize current evidence regarding the pathophysiology, risk factors, diagnostic pathways, clinical impact, and therapeutic approaches to PAA in the pediatric population. PAA occurs predominantly after perforated appendicitis and reflects persistent contamination and fibrin-driven loculation within the peritoneal cavity. Established predictors include fecalith presence, higher perforation severity, and elevated inflammatory markers. Diagnosis is typically established during the second postoperative week using ultrasound as first-line imaging. Management strategies vary widely, ranging from antibiotics alone to percutaneous or surgical drainage. PAA significantly increases length of stay, need for invasive procedures, and healthcare expenditure. In conclusion, PAA remains a clinically significant complication in pediatric perforated appendicitis. Standardized definitions, validated predictive tools, and high-quality trials are urgently needed to harmonize management, optimize outcomes, and reduce variability in care.