Presence of Periappendicular Abscess Calls for Interval Appendectomy after Antibiotics

Salminen R, Alajaaski J, Rautio T, et al. Appendiceal Tumor Prevalence in Patients with Periappendicular Abscess. JAMA Surg. 2025; in press.

Lee L, Feldman LS. Surgery for Appendicitis—Still Controversial? JAMA Surg. 2025; in press.

Nonoperative management of noncomplicated and complicated appendicitis is increasing in medical practice. Available data have suggested that appendectomy is associated with fewer complications in patients with appendicoliths and that periappendiceal abscess is associated with increased risk for appendiceal neoplasms.

This prospective study from Finland analyzed rates of appendiceal neoplasms in patients (n = 6,165) with imaging-confirmed periappendiceal abscess cared for over the interval 2020–2022. All patients were treated with antibiotics followed by interval appendectomy.

The main outcome of interest was the incidence of appendiceal neoplasm. The rate of appendiceal neoplasm was 14.3% in patients with periappendiceal abscess compared with 1.5% in patients with uncomplicated appendicitis. Patient age was the main risk factor for neoplasm.

The authors concluded that patients older than 35 years with periappendiceal abscess should be treated with antibiotics followed by interval appendectomy.

In the editorial that accompanied the article, Lee and Feldman agreed with the recommendations. They noted that available evidence supports the conclusion that appendectomy is required in at least one-third of patients managed nonoperatively; given this evidence and the risk of appendiceal neoplasm, they recommended that immediate or interval appendectomy should be offered to all patients with appendicitis.