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Inflammatory cecal masses in patients presenting with appendicitis
1Department of Surgery, University of Hong Kong Medical Centre, Queen Mary Hospital, Pokfulam Road, Hong Kong Japan.
World Journal of Surgery
|July 3, 1999
Summary
Inflammatory cecal masses found during appendicitis surgery are often benign. Ileocecal resection is a safe and effective treatment, but malignancy must be ruled out intraoperatively.
Area of Science:
- Gastroenterology
- Surgical Pathology
- Surgical Oncology
Background:
- Inflammatory cecal masses of uncertain etiology present a surgical management challenge when initially diagnosed as appendicitis.
- Distinguishing benign from malignant causes intraoperatively is crucial for appropriate surgical strategy.
Purpose of the Study:
- To review the pathology and surgical management of patients presenting with inflammatory cecal masses during surgery for presumed appendicitis.
- To compare the outcomes of ileocecal resection versus right hemicolectomy for these conditions.
Main Methods:
- Retrospective study of 3224 patients undergoing emergency surgery for acute appendicitis between January 1990 and December 1997.
- Analysis of 52 patients (1.6%) who had ileocecal resection or right hemicolectomy for inflammatory cecal masses of uncertain etiology.
- Review of final pathologic diagnoses and comparison of operative times, morbidity, and hospital stay between the two surgical approaches.
Main Results:
- The most common diagnoses were cecal diverticulitis (50%) and appendiceal phlegmon/abscess (40%).
- Malignancy (cecal carcinoma) was found in 6% of cases.
- Ileocecal resection was associated with significantly shorter operative time (144 vs. 201 min), lower morbidity (3% vs. 22%), and shorter hospital stay (6.8 vs. 11.2 days) compared to right hemicolectomy.
- No mortality was observed in either group.
Conclusions:
- Most inflammatory cecal masses are benign and can be safely managed with ileocecal resection.
- Thorough intraoperative assessment, including examination of the resected specimen, is essential to exclude malignancy, which necessitates a right hemicolectomy.