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5 - Assessment of the pediatric patients with appendiceal mass secondary to perforated appendicitis who were treated by conservative treatment and elective interval appendectomy
Melih Akın, Meltem Kaba, Abdullah Yıldız, Canan Tanık, Başak Erginel, Nihat Sever, Çetin Ali Karadağ, Taner Kamacı, Husam Barhoom, Meltem Tokel, Ali İhsan Dokucu
Objective: Currently, management of the appendiceal masses secondary to perforated appendicitis are controversial in the literature. Today, generally conservative treatment followed by interval appendectomy is performed. Aim of this study is to evaluate patients who were performed interval appendectomy after conservative treatment.
Material and Methods: A retrospective review of all patients undergoing interval appendectomy after conservative treatment was performed. Patients were evaluated for demographic data, symptoms and duration, leukocyte counts (WBC), c-reactive protein values (CRP), ultrasound (USG) findings, antibiotic regimens, operation findings, duration of hospitalization, timing of interval appendectomy. Appendectomy specimens were evaluated by pathological analysis.
Results: Between January 2010 to April 2014, 21 patients (9 male) were admitted to our clinic with acute appendiceal mass. Mean of the ages was 11.2±3.5 years, the most common symptoms were abdominal pain and vomiting, median of duration of symptoms was 6 (2-14) days. The values of WBC counts and CRP on admission and discharge were 17.8 (6-25.1)x103/mm3 and 10.1 (7.5-14)x103/mm3 for WBC, 10.8(11-321.2) mg/dl and 13.1 (0-59) mg/dl for CRP respectively. Acute appendiceal mass was defined with the USG in twelve patients, and with physical examination in nine patients. Tuberculosis was detected in one patient. Abscess formation was present in 6 patients. Percutaneous drainage with catheter was performed in 5 patients and aspiration in one. Median of durations of hospitalization was 6 (3-15) days on first admission. Ampicillin, gentamycin and metronidazole were started as standart therapy and were changed to ceftriaxone, piperacillin-tazobactam, ertapenem and imipenem according to clinical situation and culture results. Median of interval appendectomy time was 110 (65-199) days. Laparoscopic appendectomy was performed in 20 patients, open appendectomy in only one. On operation, there were almost normal appearance of appendix in 8, adherents to caecum and surrounding tissue in 4, adherent to omentum in 2, underwent lysis in 2, periappendicular abscess with acute appendicitis findings were revealed in one patient. One patient was operated prior to estimated time due to developing peritonitis findings in physical examination on 76th day so that she was operated before estimated time. Median of hospitalization duration of 2nd admission was 2 (1-3) days.
Conclusion: Conservative treatment followed by interval appendectomy is a safe and effective treatment in patients with appendicular mass due to perforated appendicitis. Percutaneous abscess drainage and broad-spectrum antibiotics are beneficial for conservative treatment. Tuberculosis and malignancy such as lymphomas should be remembered in patients with acute appendicular mass secondary to perforated appendicitis.
Keywords: Appendicular mass, children, interval appendectomy, conservative treatment, perforated appendicitis, percutaneous drainage
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