Appendicular mass and current clinic management : A decision to reconsiderate. About a case. Rev Chil Cir [online]. ISSN Introduction: Appendicitis is one of the main reasons for consultation and surgery in the emergency department. There is currently no consensus on the treatment of appendicular plastron, therefore, the objective of this work is to support and promote alternative deferred surgical versus medical management, as the most suitable treatment of appendiceal plastron.
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The medical approach of patients who present an appendicular plastron arouses multiple controversies and divides surgical world according to the preferred type of management: conservatory or surgically. We discuss the case of a year-old male, with Imipenem allergy, without significant medical history, who presents with pain in the right iliac fossa and in the right lumbar region, nausea and vomiting. The CT scans revealed an appendicular bloc near the terminal portion of the ileon and the dilation of the appendix.
On the 10th day it was decided to perform a surgical intervention for abscess drainage under general anesthesia with orotracheal intubation. An immediate appendectomy was prohibited. After one month, the patient presented for the clinical and imagistic follow-up evaluation. The CT scan did not reveal any peritoneal collections or the vermicular appendix.
After a successful conservative treatment associated or not with abscess drainage, a subsequent appendectomy is not necessary, although the patient must be informed about the recurrence risk. The probability of missing an insidious pathology is low, although it should not be excluded, especially for patients over 40 years old.
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[Evolutive Particularities of Appendicular Plastron in Children]
Appendicular abscess is considered the most common complication of acute appendicitis , in particular after a perforated appendix. Appendicular abscesses can arise either in the peritoneal cavity or the retroperitoneal space. Ultrasound is the first investigation advised to evaluate a suspected appendicular pathology. Findings of an appendicular abscess include:.
Particullary evolution of a patient with appendicular plastron