Management of the acute appendix mass: A survey of surgical practice
Department of Surgery, Mayo General Hospital, Castlebar. Irish medical journal
(Impact Factor: 0.51).
Management of the appendix mass is controversial with no consensus in the literature. Traditionally, the approach has been conservative followed by interval appendicectomy. A survey was distributed to 117 surgeons (100 consultants and 17 final year specialist registrars) to determine how the appendix mass is currently treated in Ireland. In total, 70 surgeons responded. 51 (73%) adopt a conservative approach initially. 48 (68%) favoured interval appendicectomy at six weeks after a period of successful conservative management. 34 (49%) gave risk of recurrence as the reason for performing interval appendicectomy and 16 (22%) would perform interval appendicectomy in order to obtain histological analysis to outrule caecal or appendiceal neoplasm. 44 (63%) opted for a laparoscopic rather than an open approach for interval appendicectomy. No consensus exists in Ireland for management of the appendix mass presenting acutely. The present series demonstrates a trend towards conservative approach initially followed by interval appendicectomy.
Available from: Jean Lubrano
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ABSTRACT: The purpose of our study was to analyze the clinical relevance of computerized tomography (CT) in providing the diagnosis of inflammatory appendix mass (IAM) in patients with acute appendicitis. The CT images of 134 patients were reviewed. Two groups of patients were made according to the presence (group 1; n = 21) or the absence (group 2; n = 113) of IAM. Clinical signs of patients, CT features, complications at surgery, and histological examinations were noted. Inter-observer agreement was assessed by using kappa statistics. Twenty-one patients presenting with CT features of IAM were diagnosed. An excellent inter-observer agreement (κ = 0.94) was assessed for the diagnosis of IAM. No significant statistical difference in the age distribution was observed between patients with IAM (mean age 55) and patients without (mean age 45) (p = 0.2232). No clinical sign showed a statistically significant association with the presence of IAM (p = 0.707) or with complication encountered at surgery (p = 0.180). Delay to CT examination was 5.4 days in patients presenting with CT features of IAM and of 1.7 days for patients presenting without (p = 0.0001). Conversely to acute appendicitis complicated by simple perforation (p = 0.153) or peri-appendicular abscess (p = 0.501), acute appendicitis presenting with IAM showed a statistically significant association with complications encountered at surgery (p = 0.0003) and the need for conversion to open surgery (p = 0.001). Performing CT in complicated acute appendicitis provides the diagnosis of IAM. Distinction of IAM appeared to be of clinical relevance, since immediate surgery in IAM was statistically associated with surgical complications and conversion to open surgery in our study.
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ABSTRACT: Background Conservative approach for complicated appendicitis has been gradually adopted in children to decrease postoperative morbidity. The first aim of this study was to assess the efficacy of a second-line antibiotics enlarged on Pseudomonas aeruginosa and Enterococcus in case of poor clinical outcome after initial conservative approach for appendiceal mass and abscess. The second aim of this study was to identify predictive factors of failure of first-line antibiotics. Methods We performed a prospective review of all the cases of appendiceal mass or abscess managed at our institution between November 2007 and September 2011 after implementation of a conservative protocol including a second-line antibiotics in case of poor initial clinical outcome. Results A total of 64 consecutive patients were included. We observed a success in 46 patients after the first-line antibiotics and in 14 of the remaining patients after the second-line. The only predictive factor of failure of the first-line antibiotics was a shorter duration of symptoms before admission (p = 0.02). Laparoscopic appendectomy was performed in all the cases (emergency or interval procedure) with six postoperative complications and two conversions to open surgery. Conclusions A gradual adapted antibiotherapy in nonoperative management of appendiceal abscess and mass is effective. We found no relevant predictive factor of failure of the first-line antibiotics.
Georg Thieme Verlag KG Stuttgart · New York.
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