Appendicular Mass in Children: Our Experience with Early Appendectomy

Abstract

Acute appendicitis remains the commonest cause of acute abdomen in children with appendicular mass as one of its common sequelae. Management of these cases can be surgical or via a conservative approach. Our study aims to express our experience as regarding the feasibility and outcome of early surgical intervention of appendicular mass in children. Patients and Methods: Our study included 48 cases of fixed appendicular mass, diagnosed by clinical examination and radiological investigations. Early surgical intervention were done for these cases either by laparoscopic or open approach. The operative complications, post-operative course, hospital stay and follow-up data were assessed. Results: In this study, 48 patients were included (26 females and 22 males), their ages ranged from 4 to 12 years with the mean age was 7.8 years. Open appendectomy was done in 34 patients and laparoscopic approach in 14 cases with conversion of two cases from laparoscopy to open approach. Symptoms and signs included vomiting, fever, abdominal pain, tenderness and palpable abdominal mass. Appendicular mass formed of bowel loops and omentum without pus formation was detected in 42 (87.5%) patients while localized pus collection in the mass was detected in 5 (10.4%) patients and frank appendicular abscess was detected in 1 patient (2.08%). Bowel injury happened in two cases (4.2%), diagnosed and managed intraoperatively and passed smoothly. Residual pus collection occured in 4 cases (8.4%). Two cases treated conservatively, while laparoscopic drainge cured the other two. Wound infections had occurred in 8 cases 16.6%). These cases were treated by IV antibiotics. Two case needed drainge and the wound layers were dissected. Conclusion: Early surgical intervention of appendicular mass in children is safe, effective and reliable approach with good outcome and low rate of complications.