FACTORS AFFECTING THE EFFECTIVENESS OF CONSERVATIVE MANAGEMENT OF APPENDICULAR MASS

Abstract

INTRODUCTION/ PURPOSE Acute appendicitis is the most common surgical emergency in children. Appendicular mass is a relatively common complication in improperly treated patients. The management of appendicular mass remains controversial. This study aims at determining factors affecting the effectiveness of conservative management of appendicular mass. PATIENTS AND METHOD This was a retrospective study of 71 children younger than 15 years with appendicular mass who managed at Basra Children’s Specialty Hospital during the period between 2015 and 2019. Factors like age of the patient, duration of symptom prior to hospital admission, size of the mass, complications, hospital stay and outcome are reviewed. RESULTS Appendicular mass complicates 3.9% of all cases of acute appendicitis. Conservative management of appendicular mass was effective in 84.5%. Appendicular mass occurred most frequently in children aged 5-10 year (48%). Male is more frequently affected than female with a ratio of 1.4. Regarding age effect on the efficacy of conservative management of appendicular mass, there is a significant association with P-value = 0.017. Duration of symptoms or size of the mass has no significant association with the success of conservative management. No mortality or major surgical complications are encountered. Although effective, conservative management prolong the length of hospital stay. CONCLUSION I concluded that conservative management of appendicular mass in children should be revised particularly in children younger than 5 years old, wherein operative treatment may be the first option. The reasons for that are high rate of failure of conservative management with early progress to appendicular abscess. These could be explained by the underdevelopment of greater omentum and so lacking of its protective effect in limiting the spread of inflammation. In addition, early appendectomy has the advantage of decreased risk of adhesive intestinal obstruction, shortening of hospital stay (so that less economic burden), and avoidance of second readmission for interval appendectomy.