Conservative treatment of appendicular mass without interval appendicectomy: is it justified?

To evaluate the justification for conservative treatment of appendicular mass without interval appendicectomy. 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. 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 after 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. Conservative management is effective in the majority of the patients. Randomized control trial is needed to study the real need of interval appendicectomy

Complications of barium studies

The objectives of our study were to know the frequency and type of complications of Barium contrast study. Material and This study was conducted in surgical unit of Postgraduate Medical Institute Hayatabad Medical Complex Peshawar. It was a descriptive study including all those patients who had some form of barium contrast studies for gastrointestinal diseases from January 2001 to December 2003. Total number of patients was 290. Patients who developed complications were only 13 [4.17%]. Referral from other centre was 75% among the complicated cases. Different types of complications noted in this study were intestinal obstruction 1.05% [n=3], failure of ileastomy/colostomy closure 2.42% [n=8], and perforation of hollow viscera 0.69% [n=2]. Overall mortality rate was 0.69% [n=2]. Frequency rate of complications in our study is higher than international studies. Complications rate can be reduced by following a standard approach to deal with acute/chronic abdomen. Barium study should be avoided in cases where there are signs of eminent intestinal obstruction or perforation