MANAGEMENT OF INFLAMMATORY APPENDICEAL MASS IN ZEWDITU MEMORIAL HOSPITAL, ADDIS ABABA, ETHIOPIA
Background: Appendiceal mass is one of the complications of acute appendicitis. The management of patients with appendiceal mass is controversial and different treatment options have been suggested.
Objective: The objective of this study was to assess the results of conservative management of patients with appendiceal mass followed by interval appendicectomy.
Methods: The study was a retrospective analysis of 73 medical records of patients with appendiceal mass who were managed conservatively between March 2007 and February 2014.
Results: Fifty patients were males and 23 patients were females making the male to female ratio of 2.2:1. The mean age was 29.6±6.3 years (range 12-68 years). The maximum incidence was in the 3rd decade. Forty one (55.8%) of the patients presented one week or more after the onset of their illness. Abdominal pain, right lower quadrant (RLQ) direct and rebound tenderness were observed in all patients. Mass was detected in the RLQ in 84.9% of the patients. Sixty five patients (89%) responded to conservative treatment and these patients were discharged after a mean hospital stay of 6.5±1.5 days (range 3-12 days). Interval appendicectomy was done for 58 patients 8-16 weeks after successful conservative management. The mean hospital stay after interval appendicectomy was 3.5±0.5 days with a range of 2-5 days. One patient (1.7%) had a wound infection. There were no deaths.
Conclusion: Initial non-operative management of appendiceal mass was successful in most cases and the complication rate after interval appendicectomy seems lower than with early operative treatment.
Key Words: Acute appendicitis, appendiceal inflammatory mass, conservative management, interval appendicectomy
Jaffe BM, Berger DH. The appendix. In: Brunicardi FC, Anderson DK, Billiar TR, Dunn DL, Hunter JG, Matthews JB et al, eds. Schwartz’s Principles of Surgery, 9th edition. New York: McGraw-Hill Companies. 2010. p. 1073-1089.
Bahram MA. Evaluation of early surgical management of complicated appendicitis by appendicular mass. International Journal of Surgery. 2011; 9(1):101-03.
Tannoury J, Abboud B. Treatment options of inflammatory appendiceal masses in adults. World J Gasroenterol 2013 Jul; 19(25):3942-50.
Mcpherson AG, Kinmonth JB. Acute appendicitis and the appendix mass. Br J Surg 1945; 32:365-70.
Nitecki S, Assalia A, Schein M. Contemporary management of the appendix mass. Br J Surg. 1993 Jan; 80(1):18-20.
Malik A., Laghari A. Aziz, Mallah Qasim, K. Altaf Hussain Talpur. Early Appendicectomy in Appendicular mass- A Liaquat University Hospital Experience. J Ayub Med Coll Abbottabad. 2008; 20(1):70-72
Jordan JS, Kovalcik PJ, Schwab CW. Appendicitis with a palpable mass. Ann Surg. 1981; 193:227-29
Vakili C. Operative treatment of appendix mass. Am J Surg 1976; 131:312-14.
Sanapathi PSP, Bhattacharya D, Amori BJ. Early laparoscopic appendectomy for appendicular mass. Surg Endosc. 2002; 16(12):1783-785.
Skoubo-Kristensen E, Hvid I. The Appendiceal Mass. Results of Conservative Management. Ann. Surg.1982; 196(5):584-87.
Russel RCG, William NS. Vermiform appendix. In: Williams NS and Bulstrode JK, eds. Short Practice of Surgery. 24th edition. London: Hachette Livre. 2004. p. 1203-1208.
Shenoy KR, Nileshiwar A. Manipal Manual of Surgery; 3rd edition. New Delhi: CBS Publishers and Distributers; 2010.
Okafor Pl, Orakwe JC, Chianakwana GU. World J Surg. 2003 Jul; 27(7):800-803
Gillick J, Velayudham M, Puri P. Conservative Management of appendix mass in children. Br J Surg. 2001; 88: 1539-1542.
De U, Ghosh S. Acute appendicectomy for appendicular mass: a study of 87 patients. Ceylon Med J. 2002; 47: 117-118.
Tingstedt B., Bexe-Lindskog E, Ekelund M, Andersson R. Management of appendiceal masses. Eur J Surg. 2002; 168:579-82.
Kumar S, Jain S. Treatment of appendiceal mass: Prospective randomised clinical trial. Indian J Gastroenterol. 2004; 23:165-67
Ahmed I, Deakin D, Parsons SL. Appendix mass: Do we know how to treat it? Ann R Coll Surg Engl. 2005; 87:191-95.
Vargas HI, Averbook A, Stamos MJ. Appendiceal mass: Conservative therapy followed by interval laparoscopic appendicectomy. Am Surg. 1994 Oct; 60(10):753-58.
Erdogan D, Karaman I, Narci A, Karaman A, Cavusoglu YH, Aslan MK, et al. Comparison of two methods for the management of appendicular mass in children. Pediatr Surg Int. 2005; 21(2):81-3.
Garba ES, Ahmed A. Management of appendiceal mass. Ann Afr Med. 2008; 7(4):200-204.
Adalla SA. Appendiceal mass: interval appendicectomy should not be the rule. Br J Clin Prac 1996; 50:168-69.
Deakin DE, Ahmed I. Interval appendectomy after resolution of adult inflammatory appendix mass- is it necessary? Surgeon. 2007; 5(1):45-50.
Okune G, Marek K. Jaroslaw MK. Management of appendiceal mass in children and adults: Our experience. Internet J Surg. 2007; 9(2)
Samuel M, Hosie G, Holmes K. Prospective evaluation of non surgical versus surgical management of appendiceal mass. J Pediatr Surg. 2002 Jun; 37(6):882-86.
Shinholimath VV, Thinakaran K, Rao TN, and Veerappa YV. Laparoscopic management of appendicular mass. J Minim Access Surg. 2011 Apr-Jun; 7(2):136-140.
Bradley EL, Isaacs J. Appendiceal abscess revisited. Arch Surg 1978; 113:130-32.
Partecke LI, Muller A, Kessler W, Diedrich S, Heidecke CD, Patrzyk M et al. Modern treatment of appendiceal mass. Chirurg. 2014 Jul; 85(7):622-627.
Tekin A, Kurtoglu HC, Can I, Oztan S. Routine interval appendectomy is unnecessary after conservative treatment of appendiceal mass. Colorectal Dis. 2008; 10:465-68.
Lai HW, Loong CC, Chiu JH, Chau GY, Wu CW, Lui WY. Interval appendectomy after conservative treatment of appendiceal mass. World J Surg. 2006; 30:352-57.
Thomas DR. Conservative management of the appendix mass. Surgery 1973; 73:677-680.
Garg P, Dass BK, Bansal AR, Chitkara N. Comparative evaluation of conservative management versus early surgical intervention in appendicular mass- a clinical study. J Indian Med Assoc. 1997; 95(6):179-180.
Kaminiski A, Liu IL, Applebaum H, Lee SL, Haigh PI. Routine interval appendectomy is not justified after initial non operative treatment of acute appendicitis. Arch Surg. 2005; 140:897-901.
Willemsen PJ, Hoorntje LE, Eddes EH, Ploeg RJ. The need for interval appendectomy after resolution of an appendiceal mass questioned. Dig Surg. 2002; 19:216-20.
Friedell ML, Perez-Izquierdo M. Is there a role for interval appendectomy in the management of acute appendicitis? Am Surg. 2000; 66:1158-1162.
Ochsner AJ. The cause of diffuse peritonitis complicating appendicitis and its prevention. JAMA. 1901; 26:1747-1754.
Yamini D, Vargas H, Bongard F, Klein S, Stamos MJ. Perforated Appendicitis: Is it truly a surgical urgency? Am Surg. 1998; 64:970-975