A Retrospective Analysis of Conservative Management Versus Early Surgical Intervention in Appendicular Lump

Abstract

IntroductionAcute appendicitis happens to be increasingly common in school-going children and early part of adult life, peak incidence reaching in the teens and early twenties. Luminal obstruction of the vermiform appendix is thought to be essential for the development of appendicular ischemia, gangrene, and perforation. The treatment of choice in acute appendicitis is emergency appendectomy. Appendicitis particularly puts the surgeon in a dilemma whenever the patient presents late by around four to seven days. In case of delay in presentation, complications like appendicular lump formation occur. The factors that make the clinical presentation inconsistent which in turn makes the diagnosis challenging in the case of acute appendicitis are the variable position of the appendix, the degree/grade of inflammation, and the age of the patient.At present, the standard treatment is the Ochsner-Sherren regimen universalized by Oschner and has been mostly practised over many decades as the standard care for the appendicular lump. Conservative regimen does not work in a few cases where urgent surgical exploration is necessary. This study was conducted to compare early appendectomy versus conservative management followed by interval appendectomy in case of appendicular mass and to make a better strategy for effective management of patients with complicated appendicitis. MethodsA total of 112 patients were diagnosed as having an appendicular lump as per the available records between June 2018 and June 2021. The total study population was divided into two comparative groups depending upon the treatment they received. The patients in group-1 received medical treatment and those in group-2 had undergone surgical management. The patients in group-1 were treated according to the Ochsner-Sherren regimen. The patients in group-2 were the patients in whom emergency appendectomy was done. If the general condition of the patient did not improve, pain and tenderness didn't subside, the size of phlegmon or abscess was increasing and other features of the acute abdomen were persistent, then it was regarded as a failure of medical treatment and the patient was prepared for surgery on an emergency basis. ResultsOut of 1192 cases of acute appendicitis admitted between June 2018 and June 2021, a total of 112 patients were diagnosed with an appendicular lump. As per the record, 64 patients were managed conventionally as per the Ochsner-Sherren regimen followed by elective interval appendectomy (group-1) and 48 cases were managed with an emergency surgical procedure (group-2).In group-1, out of 64 patients, non-operative treatment was successful in 58 patients (90.62%). Among the remaining patients, there was a failure of non-operative treatment in six patients and they were subjected to emergency surgical exploration (9.37%). So a total of 58 patients underwent interval appendectomy after six weeks. Out of 54 patients who had undergone emergency appendectomy in both groups, the per-operative finding was an appendicular lump in 55.5% of patien...

Retrospective Analysis of Right Iliac Fossa Mass: A Single-Center Study

“…Although only five patients were suspected of a mass in the abdomen, upon examination, a mass in the RIF was confirmed in all cases. According to Das et al, a patient complaining of pain four to seven days after the appearance of symptoms frequently felt a tender mass in the RIF [ 4 ].…”

“…Skoubo et al reported that conservative management of appendicular masses was successful in most cases, with lower complication rates than with early operative treatment [ 5 ]. Nonetheless, according to Das et al, early appendectomy for the removal of appendicular mass was relatively safe owing to the improvements in surgical techniques and better postoperative care [ 4 ]. It also reported that a requirement for prolonged postoperative care was observed in patients in which appendicular mass was managed conservatively compared to patients that underwent early investigations.…”

Complicated Appendicitis-Shifting towards Early Appendectomy-A Comprehensive Review

“…Laparoscopic appendectomy has contributed to this shift by providing better visualization, organ mobilization, and peritoneal lavage. [26][27][28][29][30] The advantages of early appendectomy include reduced wound infection rates, faster recovery, and shorter hospital stays. [31][32][33][34] In children, early appendectomy is associated with better outcomes compared to conservative treatment.…”

Características epidemiológico-clínicas y resultados del manejo del plastrón apendicular en pacientes adultos. Hospital de Emergencias José Casimiro Ulloa, 2020-2021

“…El manejo sigue siendo controvertido; el enfoque conservador resalta por la presunción de que el proceso inflamatorio ya está localizado y que la cirugía inadvertida es un desafío y puede ser insegura. Además, podría ser difícil identificar el apéndice y, en ocasiones, debido a una lesión involuntaria, se puede desarrollar una fístula fecal (3). Sin embargo, la información disponible sobre el tema es escaso.…”