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Predictors of Histological Evidence Suggestive of Risk of Recurrence Following Conservative Management for Appendicular Mass - Abstract

Caroline M. Smith, CK Sinha, James Corbett, A B Mathur

 

ABSTRACT

Aim

The practice of routine or selective interval appendicectomy (IA) following successful conservative treatment of appendix mass is a matter of debate. Predictors of recurrence may be elucidated by correlating demographic and disease course data with high risk histology obtained at IA.

Material and Methods

Children having undergone IA between 2002 and 2012 were identified. Histology of specimens were reviewed by two clinicians and categorised as low or high risk of recurrence. Demographic and treatment course data was analysed using Fishers exact for nominal and Mann-Whitney U test for continuous data, to demonstrate association with histological risk.

Results

Thirty-nine children were identified, median age 11 years (range 3-15) and weight 37kg (9 -77Kg). We report recurrence of symptoms in 33%. Seventy-two percent had histologically high risk of recurrence. Demographic data was comparable between the two groups. Predictors of high risk included: palpation of a clear abdominal mass on initial exam (PPV 83%), ultrasound findings of a clearly visualised appendix phlegmon (OR 5.25, p=0.038) or faecolith (OR 2.25, p=0.35), recurrence of symptoms and readmission (OR 2.4, 2.3 p=0.3, p=0.29).

Conclusion

Only ultrasound appearance of clearly defined appendix phlegmon reached statistical significance to predict outcome. This information can be used in counselling families following successful conservative treatment of an appendix mass.

Key words: appendix mass, interval appendicectomy, histology, recurrence

 

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