Ahmed Asma, Feroz Shah Huzaifa, Dominic Jerry Lorren, Muralidharan Abilash, Thirunavukarasu Pragatheeshwar
General Surgery, Ramaiah Medical College and Hospital, Bangalore, IND.
General Surgery, Jawaharlal Nehru Medical College, Aligarh, IND.
Cureus. 2020 Dec 12;12(12):e12045. doi: 10.7759/cureus.12045.
Appendiceal phlegmon is considered to be sequelae to acute appendicitis which presents as an appendiceal mass composed of the inflamed appendix, the adjacent bowel loops, and the greater omentum. The definitive diagnosis can be obtained by a CT scan of the abdomen. Though conservative management was the most practiced approach, recent studies have shifted the trends towards immediate appendicectomy for the management of appendiceal phlegmon. Thus, the management of appendiceal phlegmon has been debatable. Evidence to support this review was gathered via the PubMed database as this database uses the Medline, PubMed Central, and NLM databases and also offers a quick diverse search with up-to-date citations and numerous open-access free articles focused on Medicine. We did not include other databases like Google Scholar, Embase, and Scopus due to its limited access to free articles, recent articles, and citation information. Search terms used were combinations of "Appendicitis," "Appendiceal phlegmon", "Appendiceal phlegmon (AND) appendicectomy ". The resultant studies were reviewed and cross-referenced for additional reports. Emergency appendicectomy is defined as appendicectomy carried out during the same, initial admission. An elective or interval appendicectomy is an appendicectomy carried out four to six weeks after the initial episode at a later admission. The interval is bridged by antibiotics and conservative management. Emergency appendicectomy is considered to have a higher rate of complications when compared to conservative management for appendiceal phlegmon. However, interval appendicectomy requires multiple re-admissions, leads to delayed diagnosis of any underlying pathology, and an increased risk of recurrent appendicitis. In our review, we aimed to compare and contrast the effectiveness of the different treatment modalities available for appendiceal phlegmon. Though the meta-analyses showed an increased association of complications with emergency appendicectomy, they included studies conducted before the laparoscopic era. Emergency appendicectomy decreases the financial burden, re-admission rate, and aids in the early diagnosis of any underlying pathology. In the laparoscopic era, we can consider the shifting trends towards emergency appendicectomy for the management of appendiceal phlegmon.
阑尾蜂窝织炎被认为是急性阑尾炎的后遗症，表现为阑尾肿块，由发炎的阑尾、相邻肠袢和大网膜组成。腹部CT扫描可获得明确诊断。尽管保守治疗是最常用的方法，但最近的研究已将趋势转向对阑尾蜂窝织炎进行即时阑尾切除术。因此，阑尾蜂窝织炎的治疗一直存在争议。通过PubMed数据库收集支持本综述的证据，因为该数据库使用Medline、PubMed Central和NLM数据库，还提供快速多样的搜索，带有最新的引文以及大量专注于医学的开放获取免费文章。由于谷歌学术、Embase和Scopus等其他数据库获取免费文章、近期文章和引文信息的机会有限，我们未将其纳入。使用的搜索词为“阑尾炎”“阑尾蜂窝织炎”“阑尾蜂窝织炎（AND）阑尾切除术”的组合。对所得研究进行了审查并交叉引用以获取更多报告。急诊阑尾切除术定义为在同一初次住院期间进行的阑尾切除术。择期或间隔阑尾切除术是在初次发作后四至六周的后续住院期间进行的阑尾切除术。在此间隔期间采用抗生素和保守治疗。与阑尾蜂窝织炎的保守治疗相比，急诊阑尾切除术被认为并发症发生率更高。然而，间隔阑尾切除术需要多次再次入院，会导致对任何潜在病理状况的诊断延迟，以及复发性阑尾炎风险增加。在我们的综述中，我们旨在比较和对比可用于阑尾蜂窝织炎的不同治疗方式的有效性。尽管荟萃分析显示急诊阑尾切除术与并发症的关联增加，但它们纳入的是腹腔镜时代之前进行的研究。急诊阑尾切除术可减轻经济负担、降低再次入院率，并有助于早期诊断任何潜在病理状况。在腹腔镜时代，我们可以考虑将趋势转向对阑尾蜂窝织炎进行急诊阑尾切除术。
