[size=6]A 6 year-old presented with 10-days of symptoms and perforated appendicitis with abscess. They underwent IR percutaneous drainage of abscess. Five days later, they are clinically improved with 20 mL/d brownish fluid out of the drain. A drain study was obtained. What is the best next step in this patient’s management?

 

 

 

a Clamp drain

 

b Continue drain to gravity

 

c Place a second drain

 

d Diagnostic laparoscopy

 

e Remove drain[/size]

B

B

correct answer

b Continue drain to gravity

 

This drain study shows a connection of the abscess cavity to the cecum. Since the patient is clinically well with adequate source control, a second drain or surgical intervention are not indicated. This patient’s care should be focused on eventual safe removal of the drain. Since the drain has only been in for 5 days, the tract to the skin is not mature enough to simply remove the drain. The drain should remain to gravity until the antibiotic course is completed and the drain study should then be repeated. If there is still a fistula to the cecum, the drain can then be removed when the tract to the skin has matured (2-3 weeks). Prior to removing the drain, the drain can be clamped to ensure adequate source control.

[size=6]A 6 year-old presented with 10-days of symptoms and perforated appendicitis with abscess. They underwent IR percutaneous drainage of abscess. Five days later, they are clinically improved with 20 mL/d brownish fluid out of the drain. A drain study was obtained. What is the best next step in this patient’s management?

 

[ATTACH type=full" alt="repview.jpeg]15045[/ATTACH]

 

 

a Clamp drain

 

b Continue drain to gravity

 

c Place a second drain

 

d Diagnostic laparoscopy

 

e Remove drain[/size]

B