Appendiceal mass in children

Abstract

A total of 198 were diagnosed to have an appendiceal mass between 1982 and 1991;9 underwent appendicectomy immediately following diagnosis. One developed a wound infection. Of the remaining 189 patients 162 (85.7%) had unevenful resolution of the mass. The mean duration of hospital stay was 9.7 days. Twenty-seven patients failed to respond to initial non-operative management; 16 developed an appendix abscedd and required drainage. One patient had percutaneous drainage under ultrasound control. One of these 16 patients developed a wound infection after interval appendicectomy. Four other patients underwent appendicectomy during the initial admission because of clinical deterioration and all of them were found to have an appendix mass at operation. Three of these 4 patients developed postoperative complications (wound infection 1, intra-abdominal abscess 1, small-bowel obstruction 1). Seven other patients required admission and appendicectomy while waiting for interval appendicectomy. At operation, 5 still had an appendiceal mass/ abscess and 2 had acute appendicitis. The child with an appendiceal abscess continued to have a discharging wound for 19 days. All others, except 3 patients who were lost to follow-up, underwent interval appendicectomy. Mean duration of hospital stay for interval appendicectomy was 301 days. Two patients who did not return for elective appendicectomy developed acute appendicitis and required appendicectomy 65 days and 8 months after discharge. Three (1.9%) of 161 patients (all in the first half of the series) developed postoperative complications following interval appendicectomy (wound hematoma 1, wound infection 1. pneumonia 1). Evidence of inflammation was present on histological examination in 47.2% of the cases. These data support the belief that initial non-operative management of an appendiceal mass followed by interval appendicectomy is a safe and effective method of management.