How to treat an appendiceal inflammatory mass: operatively or nonoperatively?

INTRODUCTION: While there is consensus on how to treat acute appendicitis, the most suitable treatment for an appendiceal inflammatory mass is still debated. This study compares the outcomes of operative and nonoperative management. MATERIAL AND METHODS: We retrospectively evaluated 119 patients (2007-2011) with an appendiceal inflammatory mass, 85 of whom were treated nonoperatively and 34 operatively. Of the nonoperative patients, 69 did not receive interventional treatment and 16 underwent percutaneous drainage of an accompanying abscess; the data for these patients were analyzed separately. RESULTS: Of the noninterventional managed patients, 49 (71.0%) experienced at least one recurrence and 37 (53.6%) ultimately needed an acute surgical or radiological intervention. Of the 16 patients who underwent percutaneous drainage, 7 (43.8%) experienced at least one recurrence and 6 (37.5%) underwent an acute surgical or (second) percutaneous intervention. None of the operated patients had a recurrence and the incidence of complications was 17.6%. The incidence of underlying malignant tumor in our study population was 5.9%. In 35 patients, the definitive diagnosis remained unclear because the patients did not undergo surgery or follow-up colonoscopy after nonoperative treatment. The rate of extensive (ileocecal + hemicolonic) resection in all operated patients was 30.8%. CONCLUSION: We conclude that the high rate of recurrence and intervention in the nonoperative group and the high proportion of these patients who did not receive adequate follow-up despite the relatively high rate (5.9%) of bowel malignancy support the operative management of an appendiceal inflammatory mass. Noninterventional management or a percutaneous intervention should be reserved as a bridge to surgery for patients with a large accompanying abscess or as treatment for patients with significant comorbidity. If nonoperative treatment is chosen, follow-up colonoscopy is mandatory to exclude malignancy.

Is an isolated cleft lip an isolated anomaly?

INTRODUCTION: It is well known that patients with cleft lip/palate or cleft palate can have associated anomalies. However, there is a relative paucity of information about the possible anomalies associated with an isolated cleft lip. A recent study (Vallino et al., 2008) showed that children with cleft lip and/or alveolus often develop cleft palate-related issues. This inspired us to investigate our population. METHODS: A questionnaire was sent to the parents of 214 children with cleft lip and/or alveolus; 161 questionnaires were returned (response rate (RR): 75%) and included in our study. The study consisted of 91 boys and 70 girls (0.3-13.1 years: mean 6.8 ± 3.5 years). RESULTS: Speech and/or language problems were reported in 34% and ventilation tube insertion in 21% of children with ≥6 years' follow-up. Of the children in that group, 33% reported to have undergone an episode of acute otitis media and 11% reported five episodes or more. Additional congenital anomalies were found in 4% of children with a cleft lip and in 16% of children with a cleft lip/alveolus. CONCLUSION: Our results demonstrate that an isolated cleft lip can often be described as an isolated anomaly, although children with cleft lip and/or alveolus develop cleft palate-related issues more often than anticipated. Therefore, we suggest an intensive monitoring and treatment of children with these types of clefts.