Appendiceal Mass and Abscess

A mass is a palpable conglomeration of inflamed tissues, including the appendix and adjacent viscera. CT scan of the abdomen and appendix can delineate a phlegmon versus an abscess, the treatment of which are distinct.

A difference of opinion revolves around the necessity of an operative approach or a more conservative regimen. A conservative approach with antibiotics, the so-called Ochsner method, is an acceptable course of treatment. Ochsner defended his method based on the following three principles: first, it is more difficult to remove the appendix when a phlegmon is present; second, one can always revert to an operative approach if the patient deteriorates; third, conservative treatment works in > 80% of cases.4 A caveat however, the conservative approach requires an extended hospital stay initially, not to mention the interval appendectomy that will be performed at a later date.

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