Ann Surg Treat Res.  2017 Jun;92(6):429-435. 10.4174/astr.2017.92.6.429.

Impact of high-grade obstruction on outcomes in patients with appendiceal inflammatory masses managed by nonoperative treatment

• Kim MS
• Kim HJ
• Park HW
• Kwon HJ
• Lee SY
• Kook SH
• Park HJ
• Choi YJ

• KMID: 2387417
• DOI: http://doi.org/10.4174/astr.2017.92.6.429

Abstract

PURPOSE
To retrospectively assess the impact of high-grade obstructions identified on initial CT on outcomes of patients with appendiceal inflammatory masses managed by nonoperative treatment.
METHODS
Institutional Review Boards approved this retrospective study and informed consent was waived. Included were 52 consecutive patients diagnosed with appendiceal inflammatory masses by CT scan and managed by nonoperative treatment. The main outcome measure was treatment failure and secondary outcomes were complications and initial and total hospital stay. Patient demographics, inflammatory markers, and CT findings for presence of an appendiceal inflammatory mass and high-grade obstruction were assessed. Patients with and without high-grade obstruction were compared for patient characteristics and outcomes using Fisher exact test and Student t-test.
RESULTS
Among 52 patients, 14 (27%) had high-grade obstruction on CT examination at presentation. No significant differences were observed in patient characteristics (P > 0.05), treatment failure (P = 0.33), complications (P = 0.29), or initial (P = 0.73) or total (P = 0.72) hospitalization between patients with and without high-grade obstruction.
CONCLUSION
For patients who were managed by nonoperative treatment for appendiceal inflammatory masses, the presence of high-grade obstruction identified on initial CT scan did not significantly affect outcomes of treatment failure, complications, and initial and total hospitalization.

Keyword

Appendicitis; Treatment failures; X-ray computed tomography

MeSH Terms

Appendicitis
Demography
Ethics Committees, Research
Hospitalization
Humans
Informed Consent
Length of Stay
Outcome Assessment (Health Care)
Retrospective Studies
Tomography, X-Ray Computed
Treatment Failure

Figure

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  Fig. 1 Flow diagram for patient selection.

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  Fig. 2 A 11-year-old girl who had an appendiceal abscess with high-grade obstruction. (A) Contrast-enhanced coronal CT image shows an appendiceal abscess (arrows) with appendicolith (arrowhead), and a point of transition (open arrow) adherent to the abscess with dilated small bowel loops (SB) proximal to the transition point, indicating high-grade obstruction. (B) Follow-up CT image obtained 14 days after percutaneous abscess drainage reveals the collapsed abscess cavity (arrows) with remaining appendicolith (arrowhead). High-grade obstruction is completely relieved.

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  Fig. 3 A 46-year-old man who had a perforated appendicitis with an appendiceal abscess. (A) Coronal CT scan at presentation shows an appendiceal abscess (arrows) with inflamed appendix (arrowhead). Dilated small bowel loop (SB) with an abrupt transition (open arrow), indicating high-grade obstruction, is adherent to the appendiceal mass (arrows). (B) Follow-up CT image obtained 7 days after percutaneous abscess drainage shows nearly collapsed abscess pocket (arrowhead) at drain catheter (asterisk) site and recovering small bowel obstruction.

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