Management of appendicular mass in children

Of 66 children under 12 years of age treated for appendicular mass, seven underwent immediate surgery, and two of them developed post-operative wound infection. The remaining 59 children had conservative management which consisted of bedside observation of vital and abdominal signs, intravenous fluids and triple antibiotic therapy with ampicillin, gentamicin and metronidazole. The majority of the children responded well to this method, and in 54 (91.5%) the mass resolved completely. Two patients did not respond and required drainage of the abscess. Three other children responded initially to conservative management, but returned with recurrence of the mass. After their discharge from hospital, only 14 (24.5%) children returned for interval appendicectomy, which revealed that 13 of the 14 appendices excised still showed patent lumens. This study showed that conservative management of appendicular mass is safe and effective in children. In view of the patent appendicular lumen in those who had complete resolution of the mass, and the attendant risk of re-infection, interval appendicectomy appears to be desirable.