Comparative analysis of early exploration versus conservative approach for management of appendiceal mass

Raj Kumar, Shivam Madeshiya, V. K. Pandey, Ashutosh Shankhdhar


Background: Acute appendicitis is the most common reason for emergency abdominal surgery. Acute appendicitis is ranging from mild inflammation of mucous membrane to gangrene, perforation and peritonitis. Appendicular mass is one of its early complication developing in 2 to 6 % cases of acute appendicitis within 48 hours of attack. Objective of this study was to evaluate the outcome of early surgical exploration and its complications in respect to conservative management followed by interval appendectomy for the management of appendicular mass.

Methods: A total 46 cases with clinical feature suggestive of appendicular mass presenting in MLN Medical college, Allahabad were included in study. All cases divided into two equal groups based on mode of management of appendicular mass. Group I (early exploration) and Group II (conservative followed by interval appendectomy).

Results: Result will be analysed in terms of hospital stay, morbidity, complications and cost.

Conclusions: Early exploration for appendicular mass had advantages of total curative treatment in the index admission, shorter hospital stay, minimal morbidity and ensures early return to work and higher compliance. Operative problems such as localization of appendix, adhesiolysis and bleeding are more pronounced and troublesome with interval appendectomy. Wound infection remains common postoperative complication of early appendectomy in appendicular mass but the rate of wound infection is not so high as to preclude this early operative approach.


Appendicular mass, Morbidity, Perforation

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Ali S, Rafique HM. Appendicular mass; Early exploration vs conservative management. Professional Med J. 2010;17(2):180-4

Senapathi PS, Bhattacharya D, Amori BJ. Early laparoscopic appendectomy for appendicular mass. Surg Endosc. 2002;16:1783-5.

Tingstedt B, Bexe-Lindskog E, Ekelund M, Andersson R. Management of appendiceal masses. Eur J Surg. 2002;168(11):579-82.

Kumar S, Jain S. Treatment of appendiceal mass: Prospective randomized control trial. Indian J Gastro Enterol. 2004;23(5):165-7.

Ssfirullah. Conservative treatment of appendicular mass without interval appendectomy. JPMI. 2007;21(1):55-9.

Friedell ML and Perez-Izquierdo M. Is there a role for interval appendectomy in the management of acute appendicitis? Am Surg. 2000;68:1158-62.

Garg P, Dass BK, Bansaal AR, Chitkara N. comparative evaluation of conservative management versus early surgical intervention in appendicular mass- A clinical study. J Indian Med Assoc. 1997;95(6):179-80.

Arshad M, Aziz LA, Qasim M, Talpur KA. Early appendectomy in appendicular mass. A liaquat University hospital experience. J Ayub Med Coll Abbottabad. 2008;20(1):70-2.

De U, Ghosh S. Acute appendectomy for appendicular mass. A study of 87 patients. Ceylon Med J. 2002;47(4):117-8.

Samuel M, Hosie G, Holmes K. Prospective evaluation of nonsurgical versus surgical management of appendiceal mass. J Pediatr Surg. 2002;37:882-6.

Olika D, Yamini D, Udani VM. Non-Operative management of perforated appendicitis without peri-appendiceal mass. Am J Surg. 2000;179:177-81.

Vakili C. Operative treatment of appendix mass. Am J Surg. 1976;131:312-4.

Marya SK. Is a long delay necessary before appendectomy after appendiceal mass formation? A preliminary report. Can J Surg. 1993;36:268-70.

Sardar Ali, Rafique HM. Early exploration versus conservative management. Professional Med J. 2010;17(2):180-4.

Aranda-Narváez JM, Montiel-Casado MC, González-Sánchez AJ, Jiménez-Mazure C, Valle-Carbajo M, Sánchez-Pérez B, et al. Radiological support for diagnosis of acute appendicitis: use, effectiveness and clinical repercussions. Cir Esp. 2013;91(9):574-8.