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The management of appendiceal mass in children: is interval appendectomy necessary?
I Karaca1, Z Altintoprak, A Karkiner
1Department of Pediatric Surgery, Dr Behçet Uz Children's Hospital, Turkey.
Insights
Conservative management of pediatric appendiceal masses is effective. This approach avoids unnecessary interval appendectomy, demonstrating successful outcomes in children with localized, non-abscess appendiceal masses.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Emergency Medicine
Background:
- Appendiceal mass management in children traditionally involves appendectomy.
- Interval appendectomy is often considered after initial conservative treatment.
- Conservative approaches for pediatric appendiceal masses require further investigation.
Purpose of the Study:
- To evaluate the necessity of interval appendectomy in children with appendiceal mass.
- To assess the efficacy of conservative management for pediatric appendiceal masses.
- To determine recurrence rates after conservative treatment of appendiceal masses.
Main Methods:
- Retrospective analysis of 866 pediatric appendicitis patients (1990-1996).
- Conservative treatment (antibiotics, observation) for 17 children with appendiceal mass and no abscess.
- Abdominal ultrasonography (USG) and follow-up physical examinations used for assessment.
Main Results:
- All 17 pediatric patients with appendiceal mass and no abscess showed mass regression with conservative treatment.
- Mean hospital stay was 9.7 days.
- No recurrent appendicitis was observed during 1-7 years of follow-up.
Conclusions:
- Interval appendectomy is unnecessary for pediatric appendiceal masses without abscess formation.
- Conservative management, including antibiotics, is a safe and effective treatment.
- Localized, perforated appendiceal masses without fluid can be treated conservatively, even with delayed diagnosis.
Abstract:
In this study we aimed to show that performing interval appendectomy is unnecessary in the management of appendiceal mass in children. Between 1990 and 1996, 866 patients were treated for appendicitis. Abdominal ultrasonography (USG) was performed in patients who were admitted with abdominal pain, vomiting, and fever accompanying a mass in the right lower quadrant. Seventeen patients (12 boys and 5 girls, with a mean age of 9.5 years) with a mass in the appendiceal lodge and no abscess formation were treated conservatively. Appendectomy was performed on any patients with perforated or unperforated appendicitis who had an appendiceal abscess with a mass in the right iliac fossa. Three-agent antibiotic therapy was administered for at least 1 week. These patients were discharged after a mean hospital time of 9.7 days if regression of the mass was seen ultrasonographically. They were followed up for 1-60 months by physical examination and USG, and 11 of the 17 also underwent barium enema. USG demonstrated disappearance of the mass and barium enema showed a normal appendix in 10 of the 11 patients. No recurrent appendicitis was detected during follow-up for 1-7 years. This study shows that appendiceal masses that are perforated, but localized with no fluid content revealed by USG, can be treated conservatively even if they are detected late.