Interval appendicectomy after resolution of adult inflammatory appendix mass--is it necessary?

INTRODUCTION: The management of adult inflammatory appendix mass is evolving. Traditional management has been shown to be initially conservative, with interval appendicectomy performed after the mass resolved. This remains the most common approach in UK surgical practice. Recently, an increasing number of studies have challenged this approach. This review looks at the management of the inflammatory appendix mass in the adult in light of these recent changes and suggests a management approach based on the current evidence. METHODS: A Medline, Pubmed and Cochrane database search was performed using key words including combinations of; appendix, appendiceal, interval, appendectomy, appendicectomy, mass, abscess, phlegmon, and appendicitis. All articles were cross-referenced. FINDINGS: A conservative management approach will be successful in the majority of patients presenting with an appendix mass. The incidence of recurrence of symptoms following successful conservative management is low. CONCLUSION: After initial successful conservative management, routine use of interval appendicectomy is not justified in asymptomatic patients.