Appendix mass: Conservative management without interval appendectomy

Hoffmann, J; Lindhard, Anette; Jensen, Hans Grinsted

doi:10.1016/0002-9610(84)90476-8

Cited by 110 publications

(79 citation statements)

References 10 publications

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“…To prevent missing one of these more serious diagnoses, several authors advocate an interval appendectomy. This is the case in 0–12% of the patients and then mainly in patients over 40 years of age [13]. In our series, we found 4 times a diverticulitis and one malignancy in 53 patients who had a barium enema in the interval period.…”

Section: Discussionmentioning

confidence: 60%

The Need for Interval Appendectomy after Resolution of an Appendiceal Mass Questioned

Willemsen¹,

Hoorntje

Eddes

et al. 2002

Dig Surg

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Background: Our current treatment of an appendiceal mass is initially conservative, followed by an interval appendectomy. The necessity of this routine interval appendectomy is debatable. A study was conducted to evaluate whether surgical factors and pathological features of the excised appendices support interval appendectomy. Methods: We performed a retrospective study at the University Hospital Groningen and the Deventer Ziekenhuis. All patients diagnosed with an appendiceal mass in the period January 1991 to January 1997 were identified using the hospital database. The medical records of all these patients (n = 233, 108 M, 125 F) were reviewed. The clinical course of the appendiceal mass patients was split up into three distinct episodes: initial diagnosis and treatment of the appendiceal mass, the interval period and the interval appendectomy. Presenting symptoms, findings at clinical examination and additional imaging (ultrasound) were registered, as well as the course of the primary hospitalisation, the interval period, and the interval appendectomy. Results of histological examination of all resected specimens were reviewed. Results: It was found that clinical findings alone were not specific enough to diagnose an appendiceal mass; 47% had a palpable abdominal mass and the median temperature was 38.2°C ranging from 36 to 40.5°C. Ultrasound examination was done in 69% of patients and showed an appendiceal mass in 72%. During the interval period, 4 patients presented with an appendiceal mass needing drainage, and 3 with acute appendicitis requiring emergency appendectomy. At interval appendectomy, histological examination of resection specimen showed a normal appendix without signs of previous inflammation in 30% of cases. In addition, complications due to interval appendectomy were seen in 18% of patients, including sepsis, bowel perforation, small bowel ileus, and various wound abscesses. Conclusions: We conclude that when causes for the appendiceal mass other than appendicitis are excluded, interval appendectomy seems unnecessary in patients who respond well to initial conservative treatment.

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Section: Discussionmentioning

confidence: 60%

The Need for Interval Appendectomy after Resolution of an Appendiceal Mass Questioned

Willemsen¹,

Hoorntje

Eddes

et al. 2002

Dig Surg

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“…The published incidence of other pathologies masquerading as an appendix mass Emergency open appendicectomy 13.5% (n = 5) 10% (n = 3) 12% (n = 8) Diagnostic laparoscopy and appendicectomy 30% (n = 11) 33.3% (n = 10) 31% (n = 21) Conservative management with interval appendicectomy 43% (n = 16) 36.7% (n = 11) 40% (n = 27) Conservative management without interval appendicectomy 13.5% (n = 5) 20% (n = 6) 17% (n = 11) Table 1 The management protocol in a 29-year-old female varies from 0-12%. 12 Clearly, the exact incidence will depend on the age of patients and the level of investigations available in each centre. Respondents in this study were conservative in their management, with 87% favouring initial conservative approach with further investigations.…”

Section: Discussionmentioning

confidence: 99%

Appendix mass: do we know how to treat it?

Ahmed¹,

Deakin²,

Parsons³

2005

Ann R Coll Surg Engl

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INTRODUCTION The traditional management of appendiceal mass has been an initial conservative approach followed by interval appendicectomy. More recently, the necessity of interval appendicectomy has been questioned by a growing amount of evidence in the surgical literature. The aim of this study was to review the available scientific evidence and to determine how appendiceal masses are currently being managed in the Mid-Trent region by general surgeons.PATIENTS & METHODS A literature search using Medline, Embase, Cinahl, HMIC and Biosis was carried out. A personal or telephonic survey of all consultants and specialist registrars working in general surgery in the Mid-Trent region (n = 67) was conducted recording their management protocol of 3 different clinical scenarios -a 14-year-old boy, a 29-year-old female and a 68-year-old male. Responses of the questionnaire were entered to a database in Microsoft Access 2000 and analysed. RESULTS The results showed that there was difference of opinion on the management of appendix mass in either scenario. Appendectomy (interval or emergency) is still practised by 75% of general surgeons in the Mid-Trent region and less that 25% manage asymptomatic appendix mass without interval appendectomy. Additionally, specialist registrars appear more likely not to offer patients interval appendicectomy after successful conservative management (P < 0.05).CONCLUSIONS At present, there is no agreed consensus on the management of appendiceal mass. There is a need to develop a protocol for the management of this common problem.

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“…In the study by Youssuf et al, 77.8% of the recurrences occurred in the first 6 months and Hoffman et al in his study reported 66% of the recurrences within 2 years. 12,13 The patients who had recurrence were analyzed with respect to their age, sex, co morbidities, total count and length of hospital stay on initial admission Out of which age, sex and co morbid illness did not have any statistically significant correlation with recurrence. Kaminsky et al reported that the only factor associated with recurrence was sex.…”

Section: Discussionmentioning

confidence: 99%

A retrospective study on patients with appendicular mass after successful conservative treatment and to assess the need for interval appendicectomy

2018

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INTRODUCTIONAppendicitis is considered as the most common cause of acute abdomen in our surgical casualty and appendicectomy is the most common emergency surgery performed. The definite treatment of acute appendicitis is appendicectomy to avoid complications.1 If timely appendicectomy is not done due to any reason 2-6% of the patients develop a mass as one of the early complications.2-4 On the third day (rarely sooner) commencement of acute appendicitis, a tender mass can frequently be felt in right iliac fossa. An appendicular mass is the end result of a walled-off appendicular perforation and represents a pathological spectrum ranging from phlegmon to abscess. 2,3 This mass is composed of omentum, edematous caecal wall and edematous loop of ileum. In its natural course from 5th to l0th day, the mass either becomes larger and an ABSTRACT Background: Appendicular mass is one sequelae in unoperated cases of acute appendicitis which are managed conservatively followed by interval appendicectomy (IA). Currently the need for IA has been questioned due to low risk of recurrence. Methods: Data of all AM patients from 2005 to 2010 were collected and revised the following parameters: age, sex, length of hospital stay, symptoms and signs, total leucocyte count and USG. Those who developed similar pain and those who underwent emergency appendicectomy were considered as recurrence. Patients were grouped as: 1-patients who developed RIF pain,2-asymptomatic patients,3-patients who developed recurrent a/c appendicitis,4-patients who did not developed recurrent a/c appendicitis. Results: Of the 93 patients, 12 patients underwent IA. Average duration between mass resolution and recurrence is 4.16 months. 14.8% patients had recurrent similar abdominal pain, and only 7.4% patients had recurrent acute appendicitis. Length of hospital stay had a statistically significant correlation with recurrence. The mean TC in the group with recurrent acute appendicitis was 12,500 and asymptomatic group who had a mean TC of 10678.28 which was statistically significant. Conclusions: Conservative treatment is successful for majority of appendicular masses. A routine IA seems unnecessary. Asymptomatic patients can be followed up without IA. Most of the recurrences occur within the first 3 to 6 months. Length of hospital stay and total leucocyte count influenced the recurrence. IA may be considered in those who are prone for recurrence.

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Appendix mass: Conservative management without interval appendectomy

Cited by 110 publications

References 10 publications

The Need for Interval Appendectomy after Resolution of an Appendiceal Mass Questioned

The Need for Interval Appendectomy after Resolution of an Appendiceal Mass Questioned

Appendix mass: do we know how to treat it?

A retrospective study on patients with appendicular mass after successful conservative treatment and to assess the need for interval appendicectomy

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