Appendicular Mass: A Conservative Approach

Koirala, Ashok; Thakur, Dipendra; Agrawal, Sunit; Pathak, Kamal; Bhattarai, Manoj; Sharma, Anuj

doi:10.3126/jonmc.v5i2.16317

Cited by 5 publications

(5 citation statements)

References 9 publications

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“…Failure of conservative treatment was encountered in 5 patients (2%) which is similar to study carried out by Ashok Koirala. 11 Regarding the operative and post-operative complications among both groups the emergency group was ahead in all respects (figures and tables 6a and 6b), similar observations were seen by E.S. Garba 12 where they observed that complication rate of about 36%, almost comparable to that for perforated appendicitis and Immediate surgery leads to dissemination of infection and intestinal fistula formation.…”

Section: Discussionsupporting

confidence: 76%

Management of Appendicular Lump at Tertiary Care Hospital

Gilkar¹,

Mushtaq²,

Peer³

et al. 2019

jebmh

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BACKGROUNDAmong the acute surgical conditions, acute appendicitis is encountered in 2-6% of Patients. If appendectomy is not done, a lump is formed in about 3-6% of cases. After the onset of symptoms, a lump is formed after 48-72 hours and signifies obstruction and risk of perforation and consequent complications. MATERIALS AND METHODSThis study consists of 356 patients which were diagnosed by physical examination, ultrasound and computed tomography (CT) as cases of appendiceal mass and were treated at the department, from October 2014 to October 2018. Patients were divided into two groups group (A) consists of those who underwent emergency surgery for appendicitis and who underwent emergency surgery after conservative management and group (B) consists of those with a lump and were subjected to conservative management. Clinical parameters that were evaluated were age, gender, demography, operative time, hospital stay, intraoperative and post-operative complications. RESULTSMean age of the patients in our study was 22.25 with male-female ratio of 1.49. Mean operative time in group (A) was 95 minutes and in group (B) was 60 minutes. In our study of 356 patients, we encountered more difficulty in dissection and other complications in an immediate surgical group (A) while in group (B) the incidence of these complications was significantly low and p-Value was significant <0.005. CONCLUSIONIn our study of 356 patients, we have successfully managed 284 patients conservatively and subjected them to interval appendectomy. The patient should receive primary nonsurgical treatment with antibiotics and abscess drainage as needed. Emergency exploration of an appendicular lump should be avoided as it leads to dissemination of infection and intestinal fistula formation. After successful nonsurgical treatment, interval appendectomy is indicated.

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Section: Discussionsupporting

confidence: 76%

Management of Appendicular Lump at Tertiary Care Hospital

Gilkar¹,

Mushtaq²,

Peer³

et al. 2019

jebmh

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“…However, few patients may suffer complications, but those complications can also be successfully managed by surgical intervention. 19 In another study, Elsaady A et al concluded that conservative management protocol is quite safe and effective with no significant surgical difficulties in patients who failed the conservative management. They further concluded that the rate of recurrence in patients successfully treated with conservative protocol is also low.…”

Section: Discussionmentioning

confidence: 98%

Early surgery for appendicular lump in pediatric patients is still safe.

Napar¹,

N²,

Baloch³

et al. 2022

TPMJ

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Objective: To analyze the outcomes of early surgical management of appendicular lump in pediatric patients. Study Design: Prospective Observational study. Setting: Department of Pediatric Surgery, Ghulam Muhammad Mahar Medical College Sukkur. Period: January 2019 to December 2020. Material & Methods: Eighty seven patients of either gender with age up to 12 years, with diagnosis of appendicular lump were selected for this study. Variables that were analyzed include age, gender, presence of various symptoms, operative finding and difficulties, duration of surgery and duration of hospital stay. Results: Mean age of the patients was 8.22±2.35 years. Out of 87 patients, 66 (75.9%) were male and 21(24.10%) were female with male to female ratio of 3.14:1. Duration of surgery ranged from 47 to 142 minutes, with mean and standard deviation of 73.15±21.55 minutes. Intra-operatively, perforated appendix was the most common finding as was seen in 39 (44.83%) patients, followed by pus collection, which was found in 31 (35.62%) patients, appendicular abscess was seen in 26 (29.88%) patients whereas gangrenous appendix was found in 17 (19.54%) patients. Difficulty in localizing appendix was faced in 13 (14.94%) patients and difficulty in removal of adhesions was faced in 8 (9.2%) patients. Post-operative complications were seen in 22 (22.99%) patients. The duration of hospital stay ranged from 4 to 11 days with mean and standard deviation of 5.57±1.04 days. Conclusion: It is concluded in our study that early surgery in children with of appendicular lump can safely be carried out with good outcome and shorter hospital stay.

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“…The same issue is also appreciated by a vast majority of researchers who acknowledged that the efficiency of the conservative non-operative methods is displacing the need of subsequent appendectomy after the initial therapy. The underlying notion is that after an antibiotic therapy has been administered and success determined, there is no need of physicians to continue with surgical procedures as it has performed traditionally [15] . In a relatable study concerning perforated appendicitis and Phlegmon, more evidence points towards the use of conservative antibiotic therapy [16] .…”

Section: Discussionmentioning

confidence: 99%

Interval Appendectomy Operative vs. Non-Operative Management of Appendicitis in Saudi Arabia

Abouhamda

Jan

Alturkstani

et al. 2017

EJHM

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The goal of this review is to analyze the perfect mechanism for managing acute appendicitis. Both surgical and non-operative approaches are in contention as the best remedies for the appendix complications. To draw a better comparative analysis, the strengths and weaknesses of each proposed mechanism are analyzed. In the Kingdom of Saudi Arabia (KSA), both immediate and interval surgical procedure remain debatable as best remedies for acute appendicitis. To determine the suitability of both immediate and interval appendectomy against non-operative management in KSA, vast literature is analyzed to portray the strengths of each medical maneuver. Background: The primary objective of appendicitis management is to ensure early diagnosis and prevent operative management, which is risky and costly [1]. However, this goal has remained elusive due to delayed diagnosis, a characteristic that is prevalent for most people. In an analysis concerning the changing trends of appendicitis management over the past 30 years, surgery is not the only remedy for appendicitis patients [2]. Some individuals, as exhibited by numerous studies, have been able to recover without the need for surgical procedures, currently conceptualized as appendectomy. However, concentrating on the analysis by a number of scholars, it becomes evident that some delayed attention to symptoms, mainly due to patient's ignorance, makes appendectomy inevitable. As such, the most common cause of abdominal surgical emergency is appendicitis [3]. Narrowing down to the ground situation in America, not much difference is exhibited. Appendectomy remains the most significant tool at the physicians disposal when faced with relatable appendicitis dilemmas. By the time patients seek medical attention, it is already late, an aspect that motivates physicians to put into use prompt surgical procedures. The growing attention to appendicitis management is proportional to its prevalence rate. Appendicitis accounts for approximately 40,000 hospital admissions each year in England [2]. Similarly, early studies performed by English medical scholars indicated that close to 150 people from England and Wales die from acute appendicitis [4]. The prevalence rate of appendix complications is approximately seven to eight percent of the global population. Regardless of the advanced diagnostic and surgical technology, morbidity of the complication is 10%, and the mortality rate is between 1% and 5%. Despite its high prevalence, acute appendicitis is decreasing the in the US and the European region while proportionally increasing in the developing countries, mainly due to changing lifestyles [5,6,7] .Consequently, a histopathological study on KSA in 2015 revealed that diagnosis rate of acute appendicitis was 52% while acute suppurative, acute gangrenous appendicitis and acute perforated appendicitis remained at 28%, 12.5% and 2% respectively [8]. However, it is important to acknowledge that the study was limited to one geographical area, but scientifically, the figures represent a consisten...

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Appendicular Mass: A Conservative Approach

Cited by 5 publications

References 9 publications

Management of Appendicular Lump at Tertiary Care Hospital

Management of Appendicular Lump at Tertiary Care Hospital

Early surgery for appendicular lump in pediatric patients is still safe.

Interval Appendectomy Operative vs. Non-Operative Management of Appendicitis in Saudi Arabia

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