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Early Surgical Management of Appendicular Mass in Pediatric Patients
Shumaila Israr1, Jamshed Akhtar1, Syed Muhammad Raees Hussain Taqvi1
1Department of Paediatric Surgery, National Institute of Child Health, Jinnah Sindh Medical University, Karachi, Pakistan.
Insights
Early surgery for pediatric appendicular mass is feasible and safe, reducing complications and avoiding interval appendectomy. This approach offers a streamlined treatment pathway for children with this condition.
Area of Science:
- Pediatric Surgery
- Gastrointestinal Surgery
- Surgical Outcomes
Background:
- Appendicular mass in children can present complex management challenges.
- Delayed treatment may lead to increased complications and prolonged hospital stays.
Purpose of the Study:
- To evaluate the feasibility and safety of early surgical intervention for pediatric appendicular mass.
- To compare outcomes of early surgery versus conservative management or delayed surgery.
Main Methods:
- An analytical observational study involving 60 pediatric patients diagnosed with appendicular mass.
- Patients underwent surgery after initial stabilization and investigations.
- Data on demographics, presentation, intraoperative findings, and postoperative complications were analyzed.
Main Results:
- Early surgery was feasible in 60 pediatric patients (41 males, 19 females).
- Complications occurred in 23.3% of patients, more frequently in females and those with perforated appendices or complex masses.
- Superficial wound infection (15%) and intra-abdominal collections (8.3%) were the most common complications.
Conclusions:
- Early surgical management of appendicular mass in children is feasible and associated with minimal complications.
- This approach eliminates the need for prolonged follow-up and interval appendectomy, reducing associated risks.
Objective:
To find out the feasibility and safety of early surgery in pediatric patients who presented with appendicular mass.
Study Design:
Analytical observational study. Place and Duration of Study: Department of Paediatric Surgery, National Institute of Child Health, Jinnah Sindh Medical University, Karachi, from September 2019 to April 2020.
Methodology:
This study was conducted on 60 children, who were diagnosed with appendicular mass. Patients were operated after initial stabilisation and investigations. Variables analysed included demographic characteristics, clinical presentation, intraoperative surgical difficulties and postoperative complications. Data were entered into SPSS version 22. Chi-square test and Fisher Exact test were used for finding statistical significance among variables. A p-value of <0.05 was considered as significant. Results: There were 41 (68.4%) male and 19 (31.6%) female patients with the mean age of 8.3 + 2.9 year. Mean duration of pain was 3.8 + 1.8 days. In 41 (68.4%) patients, mass was composed of appendix with adherent ileal loops and omentum, while in 19 (31.6%) patients frank pus was also found within the mass. Thirty-four (56.6%) patients had suppurative appendix without gross perforation, while in 26 (43.4%) patients partially sloughed / gangrenous perforated appendix found. Intraoperative difficulties were more in patients with complex mass (p=0.004). Postoperative complications were observed in 14 (23.3%) patients. These were more frequent in female patients (p=0.001), with sloughed, gangrenous perforated appendix (p=0.034) and complex mass (p=0.008). Superficial wound infection was the most common complication noted in 9 (15%) patients. In 5 (8.3%) children, deep seated intra-abdominal collections were found. The mean hospital stay was 3.4 + 1.5 days. Conclusion: Early surgery in pediatric patients with appendicular mass was found feasible with minimal complications. This obviated the need of prolonged follow-up and interval appendectomy with its inherent risks. Key Words: Appendicular mass, Appendicular lump, Appendectomy, Child.
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