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Of 66 children under 12 years of age treated for appendicular mass, seven underwent immediate surgery, and two of them developed post-operative wound infection. The remaining 59 children had conservative management which consisted of bedside observation of vital and abdominal signs, intravenous fluids and triple antibiotic therapy with ampicillin, gentamicin and metronidazole. The majority of the children responded well to this method, and in 54 (91.5%) the mass resolved completely. Two patients did not respond and required drainage of the abscess. Three other children responded initially to conservative management, but returned with recurrence of the mass. After their discharge from hospital, only 14 (24.5%) children returned for interval appendicectomy, which revealed that 13 of the 14 appendices excised still showed patent lumens. This study showed that conservative management of appendicular mass is safe and effective in children. In view of the patent appendicular lumen in those who had complete resolution of the mass, and the attendant risk of re-infection, interval appendicectomy appears to be desirable.

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Analysis of 30 children with hydatid cysts of the liver who were treated by partial pericystectomy and external tube drainage showed that five (21%) of 24 cases in whom clear hydatid fluid was observed during surgery developed biliary leakage. The cysts in the remaining six contained bile-stained fluid, indicating the presence of cystobiliary communications, and five of these children continued to drain bile post-operatively, in spite of appropriate precautions taken during surgery. Histological examination of the pericyst wall confirmed the presence of openings of small bile ducts in the cyst which probably caused the biliary leak. It is possible that some larger openings were overlooked during surgery. It is concluded from this study that biliary leakage during the post-operative period should be expected in a significant number of patients subjected to surgery for hydatid cysts of the liver. However, the leak is likely to cease spontaneously, providing distal biliary duct obstruction is ruled out and external tube drainage is used to prevent accumulation of bile in the pericyst cavity.

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