ABSTRACT
Background: Early appendectomy (EA) for appendicular mass (AM) has been found to be a safer alternative in various studies in adults, while very few studies report such advantages in pediatric population. The purpose of this study was to assess the safety, efficacy and practical implications of EA in pediatric patients with AM.Methods: All patients with acute appendicitis or its complications that underwent EA between January 2016 and December 2018 were retrospectively reviewed. AM was defined if any or combination of the following criteria were satisfied with other signs of appendicitis: palpable mass in right iliac fossa (RIF), sonologically identified mass in RIF, per-operatively confirmed as a mass by surgeon.Results: 37 patients (among a total of 642 patients) were determined to have AM per-operatively and were included in the analysis. 29.7% (n=11) had a contained appendicular abscess. Age group ranged from 4-12 years (mean 7.8 years). The key per-operative findings were fecolith (21.6%), gangrenous appendix (56.8%), difficult adhesiolysis (48.6%), and full thickness bowel injury (2.7%). Postoperatively, wound infection in 9 (24.3%), intra-abdominal abscess in 1 (2.7%), prolonged ileus in 2 (5.4%) and sepsis in 2 (5.4%) were managed medically.Conclusions: EA approach in AM is a safe option in children as it avoids misdiagnosis, treats complicated appendicitis early, avoids second admission, and has shorter hospital stay with better compliance. Failures of non-operative management and potentially lethal complications of complicated appendicitis are also eliminated.
ABSTRACT
Background: Appendicular mass consists of matted loops of bowel and omentum adherent to the adjacent inflamed appendix. Laparoscopic approach adds diagnostic value and allows visualization of entire abdominal viscera facilitating better and safer dissection.Methods: This is an observational prospective study done in patients presenting to Gandhi Hospital’s surgical department with incidentally detected appendicular mass on laparoscopy from August 2016 to August 2018.Results: Maximum cases belong to adolescent age group (13 out of 30). Majority of cases are male patients (24 out of 30). Each surgery took around 1 hour. No intraoperative complications occurred in 23 patients. Difficult adhesiolysis experienced in 5 patients. Serosal bowel injury occurred in 1 patient. Orals were delayed where intraoperative dissection was prolonged or difficult. Majority of patients were discharged after 3 days.Conclusions: With immediate operative management of appendicular mass presenting in early stages of inflammation, dissection can be safely proceeded with and appendicectomy can be safely performed eliminating the need for second hospitalization and risk of recurrence. The incidence of intra-operative and post-operative complications is low making laparoscopic appendicectomy in early appendicular mass a safe and feasible treatment option.
ABSTRACT
Background: This study is conducted from November 2018 to November 2019 in this institute, where comparison of performance statistics is done between CT scan and Ultrasonography in patients with complicated appendicitis scheduled for conservative management, elective or emergency surgery. Aim of the study was to evaluate and compare the performance statistics of CT scan and Ultrasonography in complicated appendicitis.Methods: The CT scan or USG findings of 87 patients were reviewed. The patients were divided into two groups i.e. CT scan group (group-1/18 patients), USG group (group-2/69 patients). Satistical analysis Student”s t-test, Fischer”s test, p-value, k-value.Results: Clinical signs, CT findings, USG findings, complications at surgery and histological examinations were noted. 2, 3, 13, patients presenting with CT features and 5, 13, 51 patients presenting with USG features of appendicular perforation, peri-appendicular abscess, inflammatory appendicular mass respectively. No clinical signs showed a significant association with the presence of appendicular perforation, peri-appendicular abscess, inflammatory appendicular mass or the complication encountered at surgery.Conclusions: In this study, by comparing CT scan group and USG group in complicated acute appendicitis, CT scan can change the plan of management in doubtful cases, decrease length of hospital stay and expenses, reduce the complication rate and negative laparotomy rate, and reduce the episodes of conversion to open surgery.
ABSTRACT
Abdominal pain with dengue fever can be a diagnostic challenge. Typically, pain is localised to the epigastric region or associated with hepatomegaly. Patients can also present with acute abdomen. We report a case of a girl with dengue fever and right iliac fossa pain. The diagnosis of acute appendicitis was made only after four days of admission. An appendicular mass and a perforated appendix was noted during appendectomy. The patient recovered subsequently. Features suggestive of acute appendicitis are persistent right iliac fossa pain, localised peritonism, persistent fever and leucocytosis. Repeated clinical assessment is important to avoid missing a concurrent diagnosis like acute appendicitis.