Interval Appendectomy
Dr Shiva Sharma
• Appendicitis - Inflammation of the appendix
• Appendiceal mass may refer to a phlegmon or
abscess
• Diagnosis based on clinical and radiological
examination
• Etiology
– Anyone with an appendix
• Signs and symptoms Appendicitis
– Kosher’s sign: Initial epigastric/periumbilical pain that
moves to the RIF course progresses
– McBurney point tenderness
– Anorexia
– Rebound
– Rigidity
– Guarding
– Psoas sign: RIF pain due to extension of the hip
– Rosving’s sign: LIF palpation causing RIF pain
– Obturator sign: flexion and internal rotation of the hip
causing pain in the hypogastrium
• Investigations
– History
– Clinical Exam
– Non-invasive Radiologic investigation
• Ultrasound
• CT scan
Interval Appendectomy for
Appendiceal Masses
• Much debate on how to manage masses
1. Antibiotics
2. Radiographic guided drainage
3. Surgery
• Debate has been ongoing for many years as to
whether or not surgery should be performed
in the acute setting
• Now the general approach is to take a
conservative approach and to treat with
antibiotics
• Radioguided follow-up with ultrasonography
to look for resolution of mass
Surgery
• Immediate
• Delayed/Interval – if patient clinically stable
and good response to antibiotics
• If necessary at all?
• Why wait?
– Complications such as fistula, abscess, wound
infections
Interval Appendectomy
• Disadvantages
– Repeat hospital admission
• Shorter length of stay
• Vargas et al American Surgery 1994
• Initial stay 7.6days, 2nd stay 1.4days with interval
appendectomy
• Advantages
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–
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Unfavourable surgical conditions avoided
Post operative complications avoided
Definitive diagnosis
Length of hospital stay post operative shorter
Missed diagnosis avoided
Hoffman et al. American Journal of Surgery 1984
59 patients, 3 caecal carcinoma and lymphoma found
Recurrent appendicitis, 9patients
• Conclusion