A comparative study of appendicular lump management

Abstract

INTRODUCTION Acute appendicitis is the commonest cause of "acute surgical abdomen". The best treatment of acute appendicitis is emergency appendicectomy. If the treatment is delayed then complications like Appendicular lump can result. 1 Delayed diagnosis changes the uncomplicated simple acute appendicitis into complicated appendicitis. 2 Appendicular lump is formed in 2-6% cases of acute appendicitis, if appendicectomy is not done. 3 The Appendicular mass is more commonly seen amongst elderly males. 4 Lump forms after 48-72 hours of first symptoms of acute appendicitis. Lump develops when appendicitis is caused by obstruction of the lumen and there is danger of perforation of appendix following ischemic necrosis and gangrene of the appendicular wall. 5 Conventional treatment according to Ochsner-Sherren regime, popularised by Oschner has been practised over many years as the standard treatment for the Appendicular lump. 6 Failure of conservative regime occurs in 2-4% cases(upto 10% cases), where urgent exploration is essential. 12 Conventional treatment is ABSTRACT Background: Acute appendicitis is the commonest cause of "acute surgical abdomen". Lump is formed in 2-6% cases of acute appendicitis. Conventional treatment according to Ochsner-Sherren regime is conservative regime which is popularised as standard treatment for appendicular lump. Failure of conservative regime occurs in 2-4% cases. The aim of our study was to develop a strategy for an effective management of appendicular lump. Methods: Total of 64 patients admitted with diagnosis of or appendicular lump was included in our study over period of 2 years and 6 months. An analysis of patients managed for appendicular lump was done. All the patients of both sexes were included. Patients with Appendicular lump were randomly divided in two groups; group I-conservative management followed by interval appendicectomy after 6 weeks, group II-immediate exploration Results: Total 598 patients admitted to hospital with diagnosis of acute appendicitis, out of which total 50 patients was having Appendicular lump suggestive of incidence of 10.7%. Age group 21-30 years includes more patients. Average duration of Right Iliac Fossa (RIF) pain was 4 days. Average length of hospital stay in Group I patients was 11 days where as in Group II patients was 4 days. Failure of conservative regime was seen in 2 cases from group I. The complications occurred were mostly pertaining to the wound in group II, one patient developed faecal fistula. There were problems of poor patient compliance, failure of treatment, residual collection/abscess, readmission and failure to locate appendix on delayed appendicectomy in group I. Conclusions: In our study, early exploration is safe, confirms the diagnosis, removes need for readmission, curative, time saving, reduces cost of management and shorten hospital stay with early return to work.