Management of Inflammatory Phlegmon in Appendicitis: Comparing the Role of Emergency vs. Interval Appendectomy at a...

Background Acute appendicitis remains a common surgical pathology, with the accepted standard of care being appendectomy. However, in cases of acute appendicitis complicated by an inflammatory phlegmon, a dilemma remains regarding the best management options. The aim of our study was to examine the outcomes for patients with an appendiceal phlegmon, comparing emergency appendectomy with those who had initial conservative management followed by subsequent interval appendectomy. Methods We performed a retrospective analysis of all patients diagnosed with acute appendicitis with inflammatory phlegmon (January 2012 to December 2022), looking into the outcomes of patients managed with emergency appendectomy versus conservative management and subsequent interval appendectomy. Results A total of 127 patients were included in our study: 85 (66.9%) underwent emergency appendectomy, and 42 (33.1%) underwent interval appendectomy. Patients who underwent emergency appendectomy had a significantly shorter duration of symptoms compared to those undergoing interval appendectomy (two vs. seven days). Furthermore, there was a higher likelihood of either a partial cecectomy or ileocolic/right hemicolectomy in those undergoing emergency appendectomy (p=0.021). However, there was no difference in 30-day morbidity or mortality. Conclusion This study highlights the challenges in managing appendiceal phlegmons. We propose that interval appendectomies should be considered for patients who present with extensive phlegmonous appendicitis and a prolonged duration of symptoms.