Abstract
A Best Evidence Topic in general surgery was written according to a structured protocol. The question addressed was ‘Appendiceal phlegmon in adults: Do we know how to manage it yet?‘. Altogether 217 papers were found on Ovid Embase and Medline, 334 on PubMed and 13 on the Cochrane database using the reported search. From the screened articles, 5 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. We conclude that the best management method is conservative only treatment without interval appendicectomy. These patients must be followed up, including colonoscopy and/or CT imaging as indicated, to investigate for conditions such as inflammatory bowel disease or malignancy masquerading as appendicitis.
Highlights
A Best Evidence Topic was constructed according to a structured protocol
The results of this article are tabulated in Appendix 1; this contains a review of the most relevant and highest quality evidence available assessing the optimal method of appendiceal mass management
The management of an appendiceal mass is an area of ongoing debate and controversy; a recent survey study by Sajid et al displayed the immense disparity in the perceived optimal management method amongst general surgeons [2]
Summary
A 29-year-old male patient presents with a 7-day history of migratory central to right lower quadrant abdominal pain. This is associated with nausea, anorexia and low-grade pyrexia. A mass like structure is palpated in the right lower quadrant. Ultrasound scanning confirms your diagnosis of an appendiceal mass. You recall the ongoing controversy around the best management options: early appendicec tomy, interval appendicectomy and purely conservative management. Unsure which is in the best interest of the patient, you resolve to check the literature for evidence
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