A 25 year old man presents with 3 days history of pain in the right lower abdomen and vomitings. Patient's general condition is satisfactory and clinical examination reveals a tender lump in right iliac fossa. The most appropriate management in this case would be -
Ans. is 'c' i.e., Oschner Sherren regimen o If an appendix mass is present and the condition of the patient is satisfactory', the standard treatment is the conservative Ochsner-Sherren regimen.o This strategy is used as the inflammatory' process is already localised and that inadvertent surgery' is dificult and may be dangerous.o It may be impossible to find the appendix and, occasionally, a faecal fistula may form.o For these reasons, it is wise to observe a non-operative programme but to be prepared to operate should clinical deterioration occur.o Criteria for stopping conservative treatment of an appendix massA rising pulse rateIncreasing or spreading abdominal painIncreasing sixe of the masso Ochsner-Sherren regimen comprises hospitalization, intravenous fluids, antibiotics, analgesics and a strict watch on the vitals and general state of the patient,o In 90-80% of the patients, the mass resolves without complications,o The remaining 10-20% need emergency operation due to spreading infection.
Immediate appendicectomy
Exploratory laprotomy
Oschner Sherren regimen
External drainage
Acute Appendicitis