This study aims to detect indications of surgical drainage after failure Ultrasound guided percutaneous drainage This study will include any male and female above 18 years old that presented with appendicular abscess Patients with appendicular abscess above the age of 18 years old All patients with generalized peritonitis or immunocompromised patients will be excluded from the study

Prospective randomized study we will collect 30 patients diagnosed with appendicular abscess and they all will undergo Ultrasound guided percutaneous drainage of abscess and the group who will fail to insert the pigtail will undergo surgical drainage we will record the time of operation, number of cases with intraoperative complications and then follow up these patients during time of hospital stay for post operative pain and paralytic ileus

Study outcomes:

Primary outcomes:

1. Incidence of intra operative complications
2. Length of operations
3. Post operative pain
4. Incidence of intraoperative complications as injury of important structures
5. Lenght of hospital stay
6. Incidence of post operative complications related to surgery as wound infection, recurrence, intestinal obstruction

Secondary outcomes:

1. Cosmotic outcomes
2. Incidence of recurrence of pathology
3. Patient satisfaction

Inclusion Criteria:

• Patients with appendicular abscess above the age of 18 years old

Exclusion Criteria:

• Generalized peritonitis and patients with signs of spreading infection, toxemia and septicemia Multi-locular appendicular abscess Immunocompromised patients, hepatic dysfunction, renal impairment, uncontrolled patients and cardiac disease

The study will include 100 patients was diagnosed with appendicular abscess in the emergency unit, department of general surgery, faculty of medicine, Assiut university