CONSERVATIVE TREATMENT OF APPENDICULAR MASS WITHOUT INTERVAL APPENDICECTOMY: IS IT JUSTIFIED?

Objective: To evaluate the justification for conservative treatment of appendicular mass without interval appendicectomy.Material and Methods: This study was conducted at the department of surgery Postgraduate Medical Institute HMC Peshawar. It was a descriptive study including all those patients who presented with appendicular mass from January 2000 to December 2005. These patients were treated conservatively Patients who responded to conservative treatment were sent home and were followed for months for any recurrent attack. Patients who did not respond to conservative treatment, were explored after further investigation. Patients who had recurrent attack in the follow up were offered appendicectomy. No patient was offered interval appendicectomy.Results: Total number of the patients included in the study was 125. Patients responded to conservative treatment were 88% (n=110). Failure of conservative treatment occurred in 12% (n=15). Out of these, abscess formation occurred in 8% (n=10) who responded well to open drainage with out appendicectomy while 4% (n=5) were explored alter CT abdomen. Appendicitis was found in 2 cases (1.6%), ileoceacal tuberculosis, colonic tumour and appendicular tumour in 1 case each (0.8%). All patients except for the 5 cases already explored were followed up for 18 months. Recurrent attack of acute appendicitis occurred only in 8.33% (n=10/120) and appendicectomy was performed on these patients.Conclusion: Conservative management is effective in the majority of the patients. Randomized control trial is needed to study the real need of interval appendicectomy.