Management of Appendicular Lump at Tertiary Care Hospital

Abstract

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.