Redefining Management Strategy for An Appendicular Lump

• Main Author: Amit Tiwari, Tanweerul Huda, Vishal Bansal, Navneet Mishra
• Format: Article
• Language: English
• Published: Bulgarian Association of Young Surgeons 2020-10-01
• Series: International Journal of Surgery and Medicine
• Subjects: appendicitis; appendicular lump; appendectomy; conservative; ochsner sherren regime
• Online Access: http://www.ejos.org/index.php?fulltxt=115518&fulltxtj=136&fulltxtp=136-1596054070.pdf

Background: Acute appendicitis is the most common surgical condition for which definitive treatment is an emergency appendectomy. If the treatment is delayed, appendicular lump/ abscess can result in 2-6% cases. Conventionally an appendicular lump is treated conservatively by Ochsner-Sherren regimen but 10–20% of such patients fail to respond and later on require difficult operative intervention and there are exclusions for conservation also. Our study aims to develop a strategy for definitive management of appendicular lump. Methods: Study was conducted on 54 patients admitted in L N medical college and J K Hospital with a diagnosis of appendicular lump clinically and radio-logically. All patients of both sexes, age 11 to 60 years were included. Patients were divided into two groups, Group 1- early surgical exploration and Group 2- conservative approach with Ochsner Sherren regimen followed by interval appendectomy. Results: Out of 54, maximum patients were in the age group of 21–30 years. The average duration of symptoms were 3-4 days. Group 1 included 34 patients who had an early surgical intervention and the second group of 20 patients was managed conservatively followed by interval appendectomy in 16 patients while 4 patients were lost to follow up. Mean hospitalization time was 4-5 days in Group 1 and 7-10 days in Group 2. No major differences were seen in postoperative complications in both the groups whether operated early or late after conservative management. Conclusion: With the availability of modern operative & anaesthesia facilities, operative skills and good antibiotics a predictable and definitive course can be opted by an early exploration of the appendicular mass of any duration as it is the definitive treatment, reduces the hospital stay and more psychological satisfaction to patient and relatives and cost-effective too.