Nonoperative management of perforated appendicitis without periappendiceal mass

Oliak, David; Yamini, Dan; Udani, Vikram M.; Lewis, Roger J.; Vargas, Hernan I.; Arnell, Tracey D.; Stamos, Michael J.

doi:10.1016/s0002-9610(00)00299-3

Cited by 105 publications

(87 citation statements)

References 18 publications

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“…Some authors favor this approach on the ground that it is effective in the majority of patients. [16][17][18] What are the reasons for justifying interval appendicectomy? It is first to prevent recurrence of acute appendicitis and second to avoid misdiagnosing an alternative pathology such as malignancy.…”

Section: Discussionmentioning

confidence: 99%

“…It is said to be feasible, safe, and cost-effective, allowing early diagnosis and treatment of unexpected pathology. 18 However, the appropriate timing for emergency surgery is contentious. 18 One method involves immediate appendicectomy as soon as there is resolution of the mass before patient is discharged home during the initial admission.…”

Section: Approach B Immediate Appendicectomy Following Inflammatory Mmentioning

confidence: 99%

“…18 However, the appropriate timing for emergency surgery is contentious. 18 One method involves immediate appendicectomy as soon as there is resolution of the mass before patient is discharged home during the initial admission. However some more aggressive surgeons actually embark on right hemicolectomy for appendiceal mass as soon as the patients present.…”

Section: Approach B Immediate Appendicectomy Following Inflammatory Mmentioning

confidence: 99%

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Management of appendiceal mass

Garba

Ahmed

2008

Ann Afr Med

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Background:The management of appendiceal mass is surrounded with controversy. Traditional management has been conservative, with interval appendicectomy performed weeks after the mass had resolved. This remains the most common approach at many centers in the world. Recently, an increasing number of studies have challenged this approach. This article reviews some of the controversial issues in the management of appendix mass, assesses current practice and suggests an appropriate approach for the management of appendix mass. Methods: A Medline, Pubmed and Cochrane database search were used to find such key words and combinations of: appendix, appendiceal, appendicular, interval, appendectomy, appendicectomy, mass, abscess, phlegmon, and appendicitis. Results were saved and managed by Reference manager 11. All articles were cross-referenced by the authors. Results: A conservative management is still a highly acceptable approach for appendix mass. This should be followed with interval appendicectomy especially in patients with persistent right iliac fossa pain. Conclusion:We recommend initially conservative approach to the management of appendiceal mass especially in our environment. Keywords: Appendiceal mass, appendix abscess, appendix phlegmon, appendicitis, interval appendicectomyRésumé Contexte: La prise en charge du plastron appendiculaire est entoure de controverses. Le traitement usuel a toujours été conservateur avec l'appendicectomie réalisée plusieurs semaines après la fonte de la masse. C'est l'attitude la plus commune dans la plupart des centres à travers le monde. Récemment, un nombre croissant d'études ont conteste cette approche. Cet article passe en revue certaines controverses dans la prise en charge du plastron appendiculaire, présente les pratiques actuelles, et suggère une approche appropriée de la prise en charge du plastron appendiculaire. Méthode: Une recherche dans les bases documentaires Medline, Pubmed et Cochrane ont été faites par la recherche et la combinaison des mots clés que sont: appendice, appendiculaire, intervalle, appendicectomie, masse, abcès, phlegmon et appendicite. Les résultats ont été sauvegardes et traites a l'aide de Référence Manager 11. Tous les articles ont été recoupes par les auteurs. Résultats: Un traitement conservateur est encore une approche très acceptable pour le plastron appendiculaire. Cela devrait être suivi à distance par une appendicectomie particulièrement chez les patients ayant une douleur persistante de la fosse iliaque droite. Conclusion: Nous recommandons initialement une approche conservatrice pour la prise en charge du plastron appendiculaire particulièrement dans notre contexte.

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Section: Discussionmentioning

confidence: 99%

Section: Approach B Immediate Appendicectomy Following Inflammatory Mmentioning

confidence: 99%

Section: Approach B Immediate Appendicectomy Following Inflammatory Mmentioning

confidence: 99%

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Management of appendiceal mass

Garba

Ahmed

2008

Ann Afr Med

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“…Oliak et al [18] reported a series of 77 patients with perforated appendicitis and no palpable mass. These patients were initially treated nonoperatively, in many cases without drainage of a radiologically-confirmed abscess.…”

Section: Source Control For Lower-risk Patients With Community-acquirmentioning

confidence: 99%

“…It has also been suggested that recurrent appendicitis, when it does occur, has a more benign presentation than when it was diagnosed originally [24,27]. Moreover, interval appendectomy has complications associated with its use [18,26,28]. An argument in favor of interval appendectomy has been made based on the fact that important pathological findings are often found in the resected specimen and that an underlying tumor or other important lesion might still be present even with negative diagnostic imaging studies [21,29,30].…”

Section: Complicated Intra-abdominal Infections S-55mentioning

confidence: 99%

Clinical Challenges and Unmet Needs in the Management of Complicated Intra-abdominal Infections

Mazuski

2005

Surgical Infections

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Methods: Based on a review of the literature, treatment guidelines, and expert opinion, the challenges of managing patients with complicated intra-abdominal infections are summarized using a patient stratification approach: "Lower risk" of treatment failure and death vs. "higher risk."Results: Risk factors for treatment failure and death can be grouped into several categories, including the patient's pre-existing medical comorbidities and physiological response to the infection, the extent of the intra-abdominal infection, and the presence of specific pathogenic microorganisms. These latter factors may be more useful than the Acute Physiology and Chronic Health Evaluation (APACHE) II score in evaluating specific management strategies for patients with complicated intra-abdominal infections. The principal goal of treatment in lower-risk patients is to avoid morbidity related to source control procedures and antimicrobial therapy. Limitation of the scope of source control procedures and utilization of short-duration, narrow-spectrum, low-toxicity antimicrobial regimens is advisable to avoid adverse drug reactions and selection of resistant organisms. For higher-risk patients, the goal is to develop improved management modalities, so that morbidity and mortality are reduced. The recommended approach for higher-risk patients is to identify the most appropriate source control procedure and antimicrobial therapy, as dictated by the patient's specific risk factors, and to utilize the optimal tools of critical care medicine to treat these critically ill, septic patients. The emergence of bacterial resistance also must be considered when selecting antimicrobial therapy for both low risk and high risk patients with intra-abdominal infections. Because aminoglycoside regimens are becoming less favored, and optimal therapeutic strategies have not been standardized, the use of new treatment options (e.g., tigecycline) may be valuable when managing patients with intra-abdominal infections. especially for resistant isolates.Conclusions: The management of lower-risk patients with intra-abdominal infections is distinct compared with patients at higher risk due to compromised physiological status, extent of intra-abdominal infection, or presence of nosocomial pathogens associated with higher-

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Histologic Severity of Appendicitis Can Be Predicted by Computed Tomography

Hansen¹

2004

Arch Surg

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Nonoperative management of perforated appendicitis without periappendiceal mass

Cited by 105 publications

References 18 publications

Management of appendiceal mass

Management of appendiceal mass

Clinical Challenges and Unmet Needs in the Management of Complicated Intra-abdominal Infections

Histologic Severity of Appendicitis Can Be Predicted by Computed Tomography

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