Early Appendicectomy Versus Conservative Management for Appendicular Mass: A Comparative Study

Background: Appendicular mass, a common complication of acute appendicitis, typically develops after three days of symptom onset. Management strategies vary from surgical intervention to conservative treatment. Aim and Objectives: This study aimed to compare the outcomes of early appendicectomy versus conservative management followed by interval appendicectomy for appendicular mass, and to evaluate the overall efficacy of appendectomy. Material and Methods: This prospective study, conducted at VIMSAR, Burla (October 2016 - October 2018), included 60 patients with appendicular mass. Patients were randomized into Group A (early appendicectomy after resuscitation) and Group B (initial conservative treatment with antibiotics, followed by interval appendicectomy 6-8 weeks later). Results: The cohort comprised 45 males (75%) and 15 females (25%), with a 3:1 male-to-female ratio and a median age incidence in the 26-30 years group (23%). All patients presented with abdominal pain, fever, a palpable right iliac fossa mass, and tachycardia; 80% reported vomiting/nausea. Leukocytosis (>12,000/mm3) was found in 93% of patients. Symptom duration ranged from 2-7 days, and 90% had no prior appendicitis history. Total hospital stay was significantly shorter in Group A, requiring one admission versus two in Group B. However, Group A had a higher overall complication rate. Interval appendectomy in Group B was surgically challenging in 15% of cases due to dense adhesions. Conclusion: Early appendicectomy appears to be a superior and safer treatment option for appendicular mass compared to conservative management followed by interval appendectomy, despite a higher complication rate in the early intervention group.