Nonoperative Management for Peri-Appendiceal Abscesses after Percutaneous Drainage Without Interval Appendectomy

Background: Initial non-operative management (NOM) with percutaneous drainage for peri-appendiceal abscesses has been proven to be safe and effective. However, the appropriateness of interval appendectomy after NOM is still a matter of debate. The aim of this study was to investigate the feasibility of NOM without performing interval appendectomy.Methods: A retrospective review of medical records was performed for patients who were admitted with peri-appendiceal abscesses between January 2009 and December 2019. After percutaneous drainage for the abscesses, whether to undergo interval appendectomy was decided by the patients. Their clinical courses were reviewed thoroughly through their medical records. Telephone contact with these patients was made when necessary. Results: Twenty-seven patients were enrolled, with a mean age of 63.1 years (± 11.9 years). The median follow-up period was 25.7 months. The most common co-morbidities were cardiovascular disorders (eight patients) and underlying malignancies (eight patients). The mean size of the abscesses was 5.4 x 4.1 ㎝. Three patients consequently received surgery for the recurrence of appendicitis or peri-appendiceal abscesses. One patient received a right hemicolectomy, and another two received open appendectomies. Four patients (14.8%) died within the follow-up period due to underlying diseases.Conclusion: Initial NOM without interval appendectomy was a safe option in selected patients with peri-appendiceal abscess.

The Histopathology of the Appendix in Children at Interval Appendectomy

Whilst most surgeons agree that conservative treatment of appendiceal abscess in children is an adequate treatment, the need for subsequent interval appendectomy is still controversial. We analyzed the histopathology in interval appendectomy in search of signs of inflammation. All patients admitted between 2010 and 2017 with appendiceal abscess and scheduled for interval appendectomy were reviewed. The specimens were evaluated for grade of inflammation, type and distribution of cellular infiltrate, presence of necrosis or hemorrhage and infiltrate in the serosa. Forty-two patients had appendiceal abscess and were treated conservatively. Seven underwent emergent appendectomy. Thirty-three out of 35 patients underwent elective interval appendectomy. Thirty-two specimens were revised. Carcinoid tumor or other malignant lesions were not found. All of them presented some amount of inflammation, grade 1 to 2 in 53%, grade 3 to 4 in 47%. Twenty-five percent of the specimens had signs of necrosis accompanied by hemorrhage and in more than the half (53%) the infiltrate extended to the serosa. Conclusions: Although the appendix was mostly found not macroscopically inflamed intraoperatively, histology confirmed a certain grade of inflammation even months after the conservative treatment. No correlation was found between histopathologic findings and lapse of time between abscess treatment and interval appendectomy.

MANAGEMENT OF APPENDICULAR LUMP: SINGLE INSTITUTE EXPERIENCE IN A TERTIARY CARE CENTRE

Background/Aim: In every surgeon's routine practice, one of the most common acute surgical condition is acute appendicitis. Appendicular lump is formation occurs if treatment is delayed, in around 2- 6% of patients. The standard management of appendicular lump is conservative, followed by interval appendectomy. If conventional treatment is followed around 10-20% of the cases are not resolved and lead to gangrene or perforation followed by appendicular abscess or generalised peritonitis requiring early surgical intervention. Our study is a comparison of early exploration versus conservative management of appendicular lump. Material and Methods:Aprospective study conducted on 200 patients who presented to emergency or surgical opd at a tertiary care centre in central Rajasthan, India. All patients presenting with an appendicular lump over a period of 2 years were included in the study. The participants were divided randomly into two groups; Group 1 consisted of people who underwent early surgical intervention and group 2, consisting of people in whom conservative approach with OCHSNER SHERREN REGIME followed by interval appendectomy was done. Results: Out of 200 patients, the majority were males belonging to the age group of 15–20 years. Clinical presentation was similar among both the groups, although complications were signicantly more among Gr(P-0.04). The mean hospital stay among group 2 was 6+/-1.8 days which was substantially less than that of group 2, 8+/-2.06 days.Conclusion: Thus, we concluded from the study ndings that early surgical exploration in cases of appendicitis helps in early diagnosis and treatment, decrease the hospital stay as well as complications thereby reducing the cost of treatment.

Single stitch Open interval appendectomy; when and why

Appendicitis is a very common cause of acute abdomen. Most of the patient admit in surgical emergency. Diagnosis usually made clinically, sonography sometimes may be helpful. Regarding management there is still controversy exists. Developed country usually performed laparoscopy appendectomy while in developing country surgical management is still in debate. Different surgeons have different opinion either emergency open or laparoscopy appendectomy or interval appendectomy. Even in open appendectomy there is still debate between classical procedure vs small incision. This study favors single stitch surgery rather than classical and laparoscopy appendectomy. this case study supports even better cosmetic and outcome than laparoscopy appendectomy.