Management of appendix mass in a Nigerian rural district

Abstract

Background: The traditional management of an appendix mass is conservative, followed by interval appendicectomy. Interval appendicectomy is now controversial.

Aim: To present an experience with the management of appendix mass among a rural people in Nigeria.

Methods: Patients presenting with appendix masses and admitted at Jasman Hospital, Udo-Ezinihitte, over a 30-year period (1977-2006) were reviewed using case notes, theatre and ward registers. Information extracted included presenting symptoms, age, gender, treatment received, and outcome. Data was analyzed by descriptive statistics.

Results: A total of 15,265 patients were seen with complaints related to the right iliac fossa in the period. Seventy-two (0.5%) of these had palpable tender masses. Seventy (97.2%) of the seventy-two were inflammatory masses of the appendix, consisting of 13 (19%) cases of frank abscesses and 57 (81%) cases of phlegmon. The male to female ratio was 1:1.2. Their ages ranged  from 6 to 68 years with an average of 37 years. Forty-nine (70%) were between 16 and 65 years.

Two patients had immediate appendicectomy. The rest (68) were placed on antibiotics on admission. Thirteen (19%) had abscesses drained, right hemicolectomy was performed in 1 of 70 (1.42%) with appendix mass. Interval appendicectomy was carried out in 28 out of 70 (40%) patients. Thirty-six (51.4%) patients did not return for scheduled appendicectomy. Abscesses recurred in 3 (4.3%) cases after initial drainage.

The appendix disappeared in 4 (5.71%) patients and was fibrosed stumps in 5 (7.1%). Two specimens showed inflammatory response three to seven months after conservative management. Two patients (4.3%) died.

Conclusion: Conservative treatment should be the initial line of management for appendiceal masses, but sometimes immediate appendicectomy, right hemicolectomy, or interval appendicectomy may be necessary.

Keywords: Right iliac fossa, Appendix mass, Interval appendicectomy