[Medical and/or surgical treatment of appendicular mass and appendicular abscess in children]

There is controversy about the immediate or delayed treatment of the cases of acute appendicitis which are diagnosed in the form of appendicular mass and/or apendicular abscess. At first, do we have to follow a medical or a surgical treatment? In those cases of conservative treatment, do we always have to carry out a delayed appendectomy? We have revised our experience to discuss the different options in order to try to define some implementation criteria.

We have revised the cases of appendicitis from January 2003 to December 2005, choosing the cases of appendicular mass on this study. We have assessed the following parameters: age, sex, days of evolution, previous diagnostic, hemogram, PCR, ultrasound, computer tomography (TAC), medical treatment, initial surgical treatment, period of treatment and types of antibiotic, surgical treatment in a second term and pathological anatomy. From the 154 appendicular processes, 10 patients were diagnosed of appendicular mass, which means 6.49%.

From the 154 appendicular processes, 10 patients were diagnosed of appendicular plastron, which means 6.49%. The age range is between 2 and 15 (average 6,9). There are no differences regarding sex, 50% each. The initial diagnosis in 60% of the cases was sharp gastroenteritis. The average of days of evolution until the definitive diagnosis was 5 days (between 1 and 10 days). In 90% of the cases the diagnosis was confirmed through ultrasound scan and two cases needed computerized tomography (CT). In two cases we had to carry out an initial surgical operation to drain the abscess. The appendectomy in a second term was carried out in 7 cases. Three cases still await operation.

Unless there is intestinal occlusion, in those patients with tender mass or appendicular abscess, we must start a medical treatment based on antibiotics and, later on, carry out the appendectomy through laparoscopy. In the period between the sharp symptoms and the definitive operation, there have not been any further complications or pathology related to the appendicular mass, despite the fact that the operations have taken place 5.5 months later on average. A proper antibiotic treatment always solves the sharp symptoms. On few occasions, besides the initial medical treatment, we have to act surgically to drain an abscess, especially on Douglas.