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

7. 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

8. 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

9. 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

10. 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

11. Conclusion