Efficacy of ultrasound-guided percutaneous drainage for periappendiceal abscess in the initial management of pediatric perforated appendicitis

To investigate the clinical efficacy of ultrasound-guided percutaneous drainage for periappendiceal abscess in children at the time of initial presentation with perforated appendicitis. A retrospective analysis was conducted on 146 pediatric cases of periappendiceal abscess hospitalized at The Second Affiliated Hospital and Yuying Children’s Hospital of Wenzhou Medical University from September 2019 to September 2024. Patients were divided into two groups: the antibiotic group (A-Group, n = 36) and the percutaneous drainage plus antibiotic group (P-Group, n = 110). Clinical outcomes, including length of hospital stay, time to fever normalization (≤37.2 °C), white blood cell count (WBC), C-reactive protein (CRP), neutrophil percentage (NEUT%), and maximum abscess diameter on ultrasound, were compared. The P-Group showed significantly shorter time to fever normalization compared to the A-Group [2.00 (1.00, 7.25) days vs. 5.00 (1.00, 12.00) days, P = 0.042]. At 3 days post-treatment, the P-Group exhibited lower WBC [8.98 (6.58, 11.81)×10⁹/L vs. 11.30 (7.37, 15.65)×10⁹/L, P = 0.032] and CRP levels [17.29 (8.86, 32.50) mg/L vs. 40.41 (20.91, 72.70) mg/L, P < 0.001]. The maximum abscess diameter in the P-Group was significantly smaller than the A-Group at 3 days [27.00 (16.00, 43.00) mm vs. 45.50 (36.25, 54.75) mm, P < 0.001], 7 days [0.00 (0.00, 34.00) mm vs. 33.00 (22.25, 47.75) mm, P < 0.001], and 10 days [0.00 (0.00, 18.25) mm vs. 23.50 (0.00, 34.50) mm, P < 0.001]. No significant difference in hospital stay was observed (P > 0.05). Ultrasound-guided percutaneous abscess drainage (UPAD) combined with antibiotic therapy is superior to antibiotic monotherapy in abscess resolution rate and inflammation control efficiency for children with perforated appendicitis complicated by periappendiceal abscess, and can be one of the preferred initial non-surgical treatments for such patients.