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Management of Appendicular Lump: Early exploration Vs conservative management

Chandra Prakash Pandey, Ram Chandra Kesharwani, Chandra Gopal Singh Chauhan, Manmohan Krishna Pandey, Purnima Mittra, Pramod Kumar, Arshad Raza.

Abstract
Background: Acute appendicitis is one of the most common acute surgical condition of the abdomen and appendicular lump is formed if treatment is delayed. It is encountered in 2 – 6%of patients. The traditional treatment of appendicular lump is conservative followed by delayed appendectomy. During conservative treatment 10-20% are not resolved and lead to gangrene or perforation followed by localized abscess or generalized peritonitis requiring early surgical intervention.

Aims & Objective: A comparison of early exploration versus conservative management of appendicular lump.

Material and Methods: A total of 632 patients were admitted in emergency and OPD of this hospital with diagnosis of appendicular lump and acute appendicitis over a period of three years, all were included in the study. All age groups and both sexes were included. The patients were divided randomly into two groups. Group I, early surgical exploration and group II, conservative approach with OCHSNER SHERREN, REGIME followed by interval appendectomy.

Results: Out of 632 patients, only 62 patients who presented with appendicular lump were reviewed, suggesting 9.81% incidence. Maximum patients were found in age group of 21–30 years. Average duration of symptoms was 4 days. Two methods were adopted for the management of appendicular lump. The first group included 31 patients who were operated immediately after investigations and second group of 31 patients were managed conservatively followed by delayed appendectomy. In the first group mean hospitalization time was 4 days. Residual abscess, adhesive intestinal obstruction, failure of treatment and readmission were not observed. In the II group mean hospitalization time 10 days, more chances of residual abscess, adhesive intestinal obstruction, failure of treatment and readmissions were noted.

Conclusion: Based on our finding, it can be concluded that early surgical exploration confirms the diagnosis and cures the problem, reduce the cost of management, shortens the convalescence and hospital stay with reasonably satisfactory outcome.

Key words: Appendicitis, Appendicular lump, Appendectomy


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