Limitation of the Interval Appendectomy for Appendiceal Mass : A Tendency and the Measures of the Cases That Dropped Out for Conservative Treatment

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  • 腫瘤形成性虫垂炎に対するinterval appendectomyの限界 : Dropout症例の傾向と対策
  • 腫瘤形成性虫垂炎に対するinterval appendecromyの限界--Dropout症例の傾向と対策
  • シュリュウケイセイセイ チュウスイエン ニ タイスル interval appendecromy ノ ゲンカイ Dropout ショウレイ ノ ケイコウ ト タイサク

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Objective: We have applied interval appendectomy (IA) for mass-forming appendicitis, but we have encountered dropout cases resulting in emergency surgery. We investigated these dropout cases and the limitation of initial conservative treatment for IA. Subjects and Methods: Of a total of 164 patients with appendicitis admitted and treated between February 2007 and July 2010, 126 underwent surgery. Of the 126 surgical cases, 11 patients underwent IA (C group, n=11) and 3 dropped out (D group, n=3). The body temperature at admission and after treatment initiation, changes in hematology and blood chemistry findings, and the maximum appendicular short axis on abdominal ultrasonography at the first examination were investigated in these 2 groups. Results: On admission, no significant differences were noted in the body temperature, white blood cell count (WBC), C-reactive protein (CRP), or maximum appendicular short axis between the 2 groups. However, when the WBC before treatment was regarded as 100%, the WBCs in the C and D groups were 53.61±16.34% and 87.20±18.18% at 72 hours after treatment initiation, and 37.03±9.45% and 105.45±19.16% at 96-120 hours, respectively, showing that the WBC reduction rate in the D was smaller than that in the C group (p<0.05). Similarly, when the value of CRP before treatment was regarded as 100%, the values were 86.06±163.33% and 204.83±259.95% 72 hours after treatment initiation and 21.66±27.15% and 47.10±4.10% at 96-120 hours, respectively, showing that the CRP reduction rate in the D was smaller than that in the C group (p<0.05). Conclusion: When clinical symptoms and findings of examinations are not improved 72-96 hours after treatment initiation, particularly when reduction rates of the WBC and CRP are small, continuation of conservative treatment should be judged as inappropriate, and the therapeutic policy should be changed to surgery.

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