Management of appendiceal mass: controversial issues revisited

Although appendix mass occurs in 10% of patients with acute appendicitis, its surgical management is surrounded with controversy. This article reviews some of the controversial issues in the management of appendix mass.

A search of the English literature was conducted for "appendiceal mass," "interval appendicectomy," and "laparoscopic appendicectomy" and manual cross-referencing.

The majority of the studies were small and retrospective. Emergency appendicectomy for appendix mass is emerging as an alternative to conventional conservative treatment. It is feasible, safe, and cost-effective, allowing early diagnosis and treatment of unexpected pathology. However, the appropriate timing for emergency surgery is not clear. After successful conservative management, interval appendicectomy is not necessary and can safely be omitted, except in patients with recurrent symptoms. In patients over 40 years of age, other pathological causes of right iliac mass must be excluded by further investigations (colonoscopy and computerized tomography scan), and a close follow-up is needed. Laparoscopic appendicectomy whether in emergency or interval settings is feasible and safe and should replace the conventional open method. Large prospective, randomized controlled trials are lacking, and therefore, such trials are needed to scientifically compare emergency surgery vs conservative management without interval appendicectomy.