Some Aspects of Diagnosis and Treatment of Appendicular Infiltration

Introduction. Appendicular infiltration is currently considered as a complication of acute appendicitis. The incidence rate of this disorder ranges between 0.2 and 5.8%. Despite a large number of studies dedicated to the issue of acute appendicitis and its complications, including appendicular infiltration, surgeons’ interest to this issue remains undiminished.

Materials and methods. The paper presents the results of a retrospective analysis of diagnosis and treatment of 57 patients admitted to MI CTH No. 8, Ufa, with a diagnosis of acute appendicitis complicated with appendicular infiltration in 2012-1017.

Results and discussion. In 32 (56.1%) patients, the infiltration was diagnosed during the surgery or diagnostic laparoscopy as an incidental find, the so-called ‘find-infiltration’. Of these, in 19 (33.3%) patients, the intraoperative find was evaluated as hard infiltration, in 13 (22.8%) — as soft. In 25 (43.9%) of patients admitted to the clinic with acute appendicitis, it was suspected that the infiltration had developed prior to surgery. Dynamic clinical and ultrasound examination in 11  patients left no doubt regarding the presence of infiltration. These patients were treated conservatively. In the remaining 14 patients, it was impossible to exclude acute appendicitis or infiltration and it was decided that diagnostic laparoscopy was indicated.

Conclusion. Diagnostic laparoscopy is the leading method for diagnosis of this complication that helps determine a treatment strategy. Surgical strategy was strictly differentiated  — at the infiltration stage  — conservative, at the abscess stage — surgical; abscess cavity dissection and draining was recommended. Appendectomy was considered acceptable in technically uncomplicated situations. All the patients following the resolution of appendicular infiltration and dissection of periappendicular abscess should receive the recommendation to have appendectomy 3–4 months after discharge

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