[Is interval appendectomy necessary after conservative treatment of appendiceal masses?]

This prospective study was conducted to investigate whether interval appendectomy was necessary after successful conservative treatment of appendiceal masses.

Thirty-seven patients with a diagnosis of appendiceal mass by physical examination and ultrasonography were initially treated conservatively with broad-spectrum antibiotics, anti-inflammatory drugs, and, if required, intravenous fluid treatment. Interval appendectomy was ruled out in 28 patients who responded well to conservative treatment, three of whom were then lost to follow-up. The remaining 25 patients (9 females, 16 males; mean age 25 years; range 17 to 54 years) were monitored for recurrent appendicitis and other causes of appendiceal mass. The mean follow-up period was 35 months (range 6 to 66 months).

The mean duration of abdominal symptoms was nine days (range 3 to 20 days). The mean length of hospital stay was 14 days (range 10 to 21 days) in patients who responded to conservative treatment. Recurrent appendicitis developed in three patients (12%; 2 males, 1 female). Two patients who presented with acute appendicitis within six months after discharge and one patient who developed chronic abdominal right lower quadrant pain unresponsive to medical treatment a year after discharge underwent appendectomy. No other complications were seen with conservative treatment.

We do not recommend routine interval appendectomy in patients who benefit from conservative treatment for an appendiceal mass unless recurrent appendicitis develops.