Study of early surgical intervention in appendicular mass

Abstract

Background: Acute appendicitis may complicate to appendicular mass. It is conventionally treated conservatively followed by interval appendicectomty. This study was conducted to determine the feasibility and safety of early appendicectomy in patients with appendicular mass.

Methods: This comparative study was conducted at Department of Surgery, Unit-I, Ghulam Muhammad Maher Medical College Teaching Hospital, Sukkur, from July 2008 to June 2011. Sixty patients with appendicular mass were included. They were divided into two groups, A & B with 30 patients each regardless of age and sex. Early appendicectomy was performed in group A within 24 hours of admission while group B patients were managed conservatively followed by interval appendicectomy. Evaluation included operative and postoperative complications, operation time, and total hospital stay.

Results: Out of 60 patients, 40 were males and 20 females, with male to female ratio of 2:1. Age range was 12-50 years, mean 24+9.25 years. Early surgical intervention was done in 30 patients. In these appendicular mass without pus formation was detected in 24(80%), localized pus collection along with mass in 4(13.33%) and frank appendicular abscess in 2(6.66%) patients. Mean hospital stay was 4.50±4.86 days. Post-operative complications such as superficial wound infection occurred in 5(16.66%), deep wound infection in 3(10%), incisional hernia in 1(3.33%) and faecal fistula in 1(3.33%) patient. Two (6.66%) cases of residual abscess were found in this study managed by antibiotics and ultrasound guided drainage. Treatment failure by conservative means, patient compliance, readmission and overall expenses were main limitations in group B patients.

Conclusion: Early surgical intervention in patients with appendicular mass is feasible and safe as compared to conservative approach.