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Interval Appendectomy

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

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Interval Appendectomy

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  1. Interval Appendectomy Dr Shiva Sharma

  2. 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

  3. 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

  4. Investigations • History • Clinical Exam • Non-invasive Radiologic investigation • Ultrasound • CT scan

  5. Interval Appendectomy for Appendiceal Masses • Much debate on how to manage masses • Antibiotics • Radiographic guided drainage • Surgery

  6. 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

  7. 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

  8. 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

  9. Advantages • 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

  10. Conclusion

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