A 26 year old male presented with 4 day history of pain in the right sided lower abdomen with frequent vomiting. Patients GC is fair and clinically a tender lump was felt in the right iliac fossa. Most appropriate management for this case would be: March 2010
Ans. C: Ochsner-Sherren regiman Appendicular mass: On the 3rd day (rarely sooner) after the commencement of an attack, a tender mass can frequently be felt in the Right Iliac Fossa (RIF) beneath some rigidity of the overlying musculature, the other quadrants of the abdomen being free from rigidity or tenderness. The mass, which at this time is not yet an appendix abscess, and may never become one, is composed mainly of the: Perforated appendix Edematous caecum + poions of the small intestine Greater omentum In its midst is a perforated or otherwise inflamed vermiform appendix. By the 4th or 5th day the mass becomes more circumscribed. As the rigidity passes off its periphery can be defined clearly. Subsequently (5th - 10th day) the swelling either becomes larger, and an appendix abscess results, or it becomes small, and subsides slowly as the inflammation resolves. Ochsner-Sherren regimen: Analgesics Bed rest Antibiotics
Exploratory laparaotomy
Immediate appendicectomy
Ochsre:-Sherren regiman
Externai drainage