A comparative study between surgical and conservative management of Appendicular mass

Background: Acute appendicitis remains the commonest cause of acute abdomen in teenagers requiring surgical intervention. Most patients presenting late in the course of acute appendicitis are complicated by the development of an inflammatory mass in right iliac fossa. This inflammatory mass is composed of the inflamed appendix, omentum and bowel loops. Aim of the work: Evaluate the outcome of emergency surgery versus conservative management in patients with complicated appendicitis with appendicular mass. Patient and Methods: A prospective study was accomplished for 60 patients who were suspected provisionally to have appendicular mass, and attended to the emergency department of Al-Azhar University Hospitals, in Cairo, Egypt, during the period from January 20/2019 to October 20/2019.The patients were divided randomly in two groups, each containing (30).In Group I : early surgical exploration was done by open appendicectomy operative procedure within 24 hrs of admission. Pre- operative preparation was done by keeping the patients nothing per mouth, giving adequate parenteral fluids to maintain fluid and electrolyte balance, antibiotics and analgesics. Drains were kept in a few cases which were removed after 48hrs and sutures were removed on the 10th post-operative day. Most of the operated patients had uneventful recovery.Post-operative period was monitored; intake output charts and vital charts were maintained .In Group II : conservative approach with Ochsner Sherren Regime was adopted followed by interval appendectomy 6-8 weeks later. Results: There was statistically significant difference between study groups in the operative findings (p<0.001).There was statistical insignificant difference between groups in operative problems (p=0.683).There was statistical significant difference between the study groups as regards complications (p=0.021) with more complications occurring in the group of patients treated by Ochsner Sherren regimen followed by interval appendicectomy and hence these patients had more morbidity. Conclusion: Early appendicectomy obviates the need for a second admission andprovides curative treatment during the index admission whereby minimizing total expenses.Early appendicectomy may also avoid the consequences of the misdiagnosis and mistreatment of other surgical pathologies.Early appendicectomy in appendicular mass is safe owing to the improvements in surgical skills and better post-operative care.