Background: Currently accepted management of periappendicular mass consists of treatment with antibiotics followed by interval appendectomy. However, debate has intensified over the necessity of elective appendectomy. The purpose of this study was to perform ultrasound assessments of patients treated conservatively for periappendicular mass to examine remaining or secondary pathology.
Methods: We invited for ultrasound examination all patients who were treated for periappendicular mass, exclusively with antibiotics, without drainage or surgery, at our medical center during the years 2003 to 2012. Scans of the right lower quadrant were performed in transverse and longitudinal planes, in the recumbent and left lateral decubitus patient positions. Anatomic landmarks such as the right colon, cecum, ileocecal valve, terminal ileum and appendix were demonstrated. The right kidney was scanned to exclude hydronephrosis, and the pelvis for the presence of free fluid. Color Doppler was used on the appendix and terminal ileum to detect any hyperemia.
Results: Of the 1667 patients hospitalized with acute appendicitis during the study period, 72 (4.3%) had periappendicular mass and were treated with antibiotics only. Four underwent emergency surgery due to recurrence: 3 within 6 months and one at 10 months after discharge. Interval appendectomy was performed in 39 patients. Of the remaining, 22 underwent sonography at a mean of 34 months, range 6 -105 months, after the original infection. Their mean age was 53 years, range: 5-86 years; 13 were males. Thickened appendices were detected in 2 patients. No other pathologies were detected in the ultrasound examination. Peritoneal fluid was not present and right kidneys were normal. All reported not having any symptoms since their hospital discharge.
Conclusion: Normal sonographic examinations following conservative treatment for periappendicular mass confirmed that elective surgery was not necessary. Recurrence seems unlikely after a period of 6 months following treatment.
