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Appendicular mass and abscess

  • Usually on third day, formation of appendicular mass is due to natural defense mechanism of body by which it try to localize the infection of appendix.
  • It is the walling off of inflamed or perforated appendix by greater omentum, oedematous caecum, oedematous terminal ileum and oedematous parities.
  • This mass is tender, variable in size with time and may have features of sub acute intestinal obstruction.
  • Differential diagnosis are carcinoma of caecum, tuberculosis of ileocaecal region, iliac lymphadenitis,  twisted ovarian cyst or carcinoma, ectopic kidney etc.
  • Ultrasonography and CT scanning help in diagnosis.
  • Preferred treatment is conservative but experience surgeon can operate it, as surgery is difficult, bloody and dangerous, while appendicular abscess do need drainage per cutaneous are open.
  • Operative treatment is indicated in appendicular mass when rising pulse is on progress , increasing or spreading abdominal pain and increasing in size of mass or diagnosis is in doubt especially at extreme of age.
  • If it resolves on conservative treatment than interval appendicectomy is must.
  • If there is central collection of puss than it is called an appendicular abscess.
  • Pelvic abscess formation is an occasional complication of appendicitis, rectal examination reveals a boggy mass in the pelvis, ultrasound or CT scan will confirm and can be treated by transrectal drainage or ultrasound guided aspiration.