Surgical and pathological basis for interval appendicectomy after resolution of appendicular mass in children

BACKGROUND/PURPOSE: The role of appendicectomy after the resolution of appendicular mass is debatable. A study was conducted to evaluate whether surgical and pathological features of the excised appendices favor the operation in the quiescent period. METHODS: During a 60-month period, 59 patients were admitted in our unit with a diagnosis of appendicular mass and were treated initially with conservative management. Five patients failed to respond to this management and they were operated on immediately. RESULTS: Fifty-four patients recovered fully, and relatives were advised to bring them back to the hospital for appendicectomy on a scheduled date after 6 weeks. Fifteen of 54 (27.7%) patients did not return, but the other 7 came back because they had symptoms of recurrent appendicitis. The remaining 32 patients underwent appendicectomy as scheduled. The surgical findings and pathological features of excised appendices showed various abnormalities. CONCLUSIONS: Considering these features it could be concluded that delayed appendicectomy is unjustified in patients with absent appendix or with its lumen obliterated, whereas the other remaining patients who harbored normal, thickened, fibrotic, transected, stump, and appendix with chronic inflammation or containing fecal casts would benefit from operation. Because we have no method to date to distinguish between these variants "in situ" delayed appendicectomy seems beneficial for all the patients who respond well to the initial management of appendicular mass.