Complications of a Ruptured Appendix

Dear Ask The Doctor: My granddaughters appendix ruptured 7 days ago. An emergency appendectomy was done. The incision was closed and no drain was left.She remains hospitalized and is still in much stomache pain. She says it is NOT where her incision is, but her entire tummy hurts. She is vomiting and not even partaking of clear broths offered her. A CT done yesterday showed 'suspicious fluid in stomache and upper colon' but they do not think it is an abcess because her white count is actually improving. I am asking what OTHER tests should be done?

Dear Barbara: Obviously, without a complete examination of your granddaughter I cannot say with absolute certainty what is wrong. However, her symptoms and the CT scan findings suggest that she may have an intra-abdominal abscess which is very likely complication of a ruptured appendix. Her decreasing white cell count does not completely rule out an abscess. At this point no other tests are indicated. She will most likely continue to be observed in hospital and receive antibiotics and painkillers. Should her condition worsen a repeat CT scan may be done which may be more definitive of an abscess. Upon confirmation of an abscess, a drain can be placed.