The Management of Appendiceal Mass in Children: Is Interval Appendectomy Necessary?

Abstract

In this study we aimed to show that performing interval appendectomy is unnecessary in the management of appendiceal mass in children. Between 1990 and 1996, 866 patients were treated for appendicitis. Abdominal ultrasonography (USG) was performed in patients who were admitted with abdominal pain, vomiting, and fever accompanying a mass in the right lower quadrant. Seventeen patients (12 boys and 5 girls, with a mean age of 9.5 years) with a mass in the appendiceal lodge and no abscess formation were treated conservatively. Appendectomy was performed on any patients with perforated or unperforated appendicitis who had an appendiceal abscess with a mass in the right iliac fossa. Three-agent antibiotic therapy was administered for at least 1 week. These patients were discharged after a mean hospital time of 9.7 days if regression of the mass was seen ultrasonographically. They were followed up for 1-60 months by physical examination and USG, and 11 of the 17 also underwent barium enema. USG demonstrated disappearance of the mass and barium enema showed a normal appendix in 10 of the 11 patients. No recurrent appendicitis was detected during follow-up for 1-7 years. This study shows that appendiceal masses that are perforated, but localized with no fluid content revealed by USG, can be treated conservatively even if they are detected late.

Management of Appendiceal Mass: Controversial Issues Revisited

“…28 Karaca et al treated 17 children with appendiceal mass out of 866 patients with acute appendicitis (1.96%) conservatively with triple antibiotics for a week. 29 The mean hospital stay was 9.7 days, and mass regression was confirmed on repeat ultrasonography. They were followed up by clinical examination and ultrasound for 1-60 months; 11 patients underwent barium enema also.…”

A review of the studies about appendicitis of the Turkish Pediatric Surgical Centers and a preliminary study to form a publishing index for pediatric appendicitis.

“…Konservatif tedavi: İki klinik tarafından izlenen ve ameliyat gerektirmeyen toplam 51 hastaya dayanıla-rak geciktirilmiş apandektominin zorunlu olmadığı öne sürülmüştür (203,(241)(242)(243)(244) .…”

Interval routine appendectomy following conservative treatment of acute appendicitis: Is it really needed

“…Interval appendectomy is traditionally performed about 6 wk after the episode of AA to prevent recurrences and remove the offending organ to permanently resolve infection [33,34] . During this time of about 6-8 wk, the local inflammatory changes usually have subsided, the edematous and inflamed bowel has recovered and the patient is appropriately prepared [32][33][34][35] . However, the need for interval appendectomy after a successful nonsurgical treatment has recently been questioned as the risk of recurrence is relatively small [12,[35][36][37] .…”

“…During this time of about 6-8 wk, the local inflammatory changes usually have subsided, the edematous and inflamed bowel has recovered and the patient is appropriately prepared [32][33][34][35] . However, the need for interval appendectomy after a successful nonsurgical treatment has recently been questioned as the risk of recurrence is relatively small [12,[35][36][37] . This issue remains highly debated, with others proposing either delayed (i.e., appendectomy during the same admission, mainly to diminish sick leave) or routine interval appendectomy [38][39][40] .…”