The evolving management of the appendix mass in the era of laparoscopy and interventional radiology

Forsyth, James Michael; Lasithiotakis, Konstantinos; Peter, Mark

doi:10.1016/j.surge.2016.08.002

Cited by 17 publications

(25 citation statements)

References 43 publications

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“…Phlegmonous appendicitis is important to identify as conservative treatment is associated with significantly less complications than immediate appendicectomy including wound infection, abscesses, obstruction and reoperation 19. The likelihood of phlegmonous appendicitis is much more likely if there is an identified fixed, palpable mass in the right iliac fossa and symptoms suggestive of appendicitis have persisted over 3 days 20. These both were present in our case and thus, similarly, had a CT scan been obtained then a trial of conservative treatment may have been considered, potentially avoiding an unnecessary right hemicolectomy in our patient.…”

Section: Discussionmentioning

confidence: 99%

Appendiceal Crohn’s disease: a rare differential of right iliac fossa pain

et al. 2020

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A 30-year-old man with a history of severe right iliac fossa pain was referred to the surgical emergency unit. His symptoms began 3 days prior as mild, non-specific abdominal pain which progressively localised to the right iliac fossa and worsened in severity. Investigations were suggestive of acute appendicitis, and therefore a laparoscopic appendicectomy was planned. Laparoscopy revealed a thickened, necrotic appendix with a mass at the base of the appendix, in keeping with the appearance of an appendiceal malignancy. Subsequently a right hemicolectomy was performed. Histology revealed active chronic inflammation and granulomas highly suggestive of appendiceal Crohn’s disease. Since, the patient has made a good recovery and presently shows no further signs of Crohn’s disease. This case is demonstrative of one of many rare findings on histological examination of the appendix. It emphasises the need for a wide differential when investigating right iliac fossa pain.

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Section: Discussionmentioning

confidence: 99%

Appendiceal Crohn’s disease: a rare differential of right iliac fossa pain

et al. 2020

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“…However, since the mainstream of treatment was early appendectomy, there were cases requiring extended resection in approximately 3 to 30%, and the subsequent perioperative complications were considerable problems [8,[11][12][13]. In recent years, with the advance of interventional radiology as well as the improvement of preoperative diagnosis, non-surgical treatment for AM has developed dramatically [14,15]. Additionally, many reports have referred to the effectiveness of IA, especially in pediatric surgery [3,4,16].…”

Section: Discussionmentioning

confidence: 99%

The effectiveness and appropriateness of Interval Laparoscopic Appendectomy on adult appendiceal mass, a retrospective cohort

Fujihata

Kitagami

Kitayama

et al. 2019

Preprint

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Background: Appendiceal mass sometimes requires extended resection and difficult to treat postoperative complications. Interval appendectomy has been performed mainly in the field of pediatric surgery to avoid them. Recently, there are a few reports on interval laparoscopic appendectomy (ILA). We examined not only the safety and effectiveness of ILA for adult appendiceal mass (AAM), but also the appropriateness of ILA for which cases should be treated non-surgically for ILA or converted to surgical treatment. Methods: Among 956 appendectomies performed between April 2012 and March 2018, there were 49 cases of AAM, of which 34 cases underwent ILA; ILA group. The safety and efficacy of ILA were examined by comparing with 477 cases of adult uncomplicated appendicitis underwent laparoscopic appendectomy (LA); LA group. The appropriateness of ILA was examined by comparing with the remaining 15 cases of AAM; non-ILA group. Results: The ILA group had a longer operation time than the LA group, but the postoperative hospital stay was shorter, and no significant difference were found in the bleeding volume, the days required for oral intake of solid food, and the perioperative complications. Examining the factors for failure of non-surgical treatment or relapse of inflammation during interval period, higher WBC day3 / day0 was found to be an independent risk factor. Conclusion: ILA against AAM was almost as safe and effective as LA for adult uncomplicated appendicitis. WBC day3 / day0 may be effective as an objective parameter for judging the termination of non-surgical treatment for ILA. This determination to convert ineffective non-surgical treatment to surgical treatment earlier may reduce the burden on the patient.

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“…We would support routine interval appendectomy only in the context of persistent right iliac fossa pain, recurrence, mass persistent beyond two weeks and patients who desire for the "diseased" appendix to be removed. 14 When treating appendix mass with antibiotic there are no specific guidelines, and the recommendation are intravenous antibiotics according to local guidelines for intra-abdominal infection/sepsis, until the patient significantly improves. Antibiotic therapy should tailor according to blood culture results.…”

Section: Discussionmentioning

confidence: 99%

“…14 Further investigation must be performed after 4-6 weeks. For pediatric patients, the most appropriate initial imaging is ultra-sonography; ultrasound or CT in younger adults and in adults over 40 CT followed by colonoscopy.…”

Section: Discussionmentioning

confidence: 99%

A survey of management of appendiceal mass among surgeons: what is best practice?

et al. 2017

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Background: An appendix mass is the result of a walled-off perforation of the appendix which localizes, resulting in a mass and it is encountered in up to 7% of patients presenting with acute appendicitis. The management of such problem is controversial. Immediate appendectomy may be technically demanding. Traditionally, management of these patients is conservative followed by interval appendectomy to prevent recurrence. However, the need for interval appendectomy has recently been questioned due to relatively small risk of recurrence. Also, there is still debate on adopting conservative management regarding the recurrence rate, the complication rate of interval appendectomy, and the potential for underlying malignancy. Our aim was to assess the preferred approach and current practice for management of acute appendix mass among surgeons in Al Taif Saudi Arabia.Methods: A questionnaire for the practice of surgeons in dealing with appendicular mass was designed and distributed to 21 consultants and 45 specialists.Results: 14.3% of consultant and 53.3% of specialist practiced the conservative management without routine interval appendectomy. Also, 14.3% and 26.7% of them respectively preferred immediate appendectomy while 71.4% of consultants and 20.0% of specialists did routine interval appendectomy. Most of the surgeons prefer to adopt the open method in immediate appendectomy while laparoscopic approach is the main adopting procedure for interval appendectomy. 57% of consultants stated risk of recurrence as the reason for performing interval appendectomy while, 53.4% of specialists would perform it to out-ruling neoplasm.Conclusions: Surgeons prefer to carry conservative approach with an interval appendectomy in management of appendix mass and laparoscopic approach for interval appendectomy. However immediate appendectomy and conservative management without interval appendectomy was preferred in other studies, which increase the necessity for national guidelines to be considered for management of this clinical condition.

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The evolving management of the appendix mass in the era of laparoscopy and interventional radiology

Cited by 17 publications

References 43 publications

Appendiceal Crohn’s disease: a rare differential of right iliac fossa pain

Appendiceal Crohn’s disease: a rare differential of right iliac fossa pain

The effectiveness and appropriateness of Interval Laparoscopic Appendectomy on adult appendiceal mass, a retrospective cohort

A survey of management of appendiceal mass among surgeons: what is best practice?

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