Tuesday, August 17, 2010
My Continued Anti-Percutaneous Drain Crusade in Appendicitis
A young kid comes into the ER with 36 hours of RLQ abdominal pain. The ER scans him. The scan shows an obvious 4cm abscess next to the appendix. What do you do?
RESIST THE URGE TO ORDER "CT GUIDED PERCUTANEOUS DRAINAGE".
Please. Just take the kid to the OR. Use your laparoscopic suction/irrigator to wash out the abscess. Remove the appendix. Leave a JP drain if you must. The kid goes home in 1-3 days. No more sitting in the hospital for a week with a foul smelling rubber tube hanging out his side. No more prolonged courses of expensive IV antibiotics. No more interval appendectomies. These patients don't need multi-staged management strategies with multiple invasive procedures. Just operate and be done with it.