Inflammatory cecal masses in patients presenting with appendicitis

Abstract

An unexpected inflammatory cecal mass of uncertain etiology encountered during surgery for presumed appendicitis poses a dilemma to the surgeon when deciding the appropriate operative management. A retrospective study was performed to review the pathology and surgical management of this condition. Among 3224 patients who had emergency surgery for a diagnosis of acute appendicitis between January 1990 and December 1997, a group of 52 patients (1.6%) underwent either ileocecal resection or right hemicolectomy for an inflammatory cecal mass of uncertain etiology. The final pathologic diagnosis was cecal diverticulitis in 26 patients (50%), appendiceal phlegmon or abscess in 21 patients (40%), cecal carcinoma in 3 patients (6%), tuberculosis in 1 patient (2%) and schistosomiasis in another patient (2%). Altogether 34 patients underwent ileocecal resection, and 18 patients underwent right hemicolectomy, including the 3 patients with cecal carcinoma. Ileocecal resection was associated with a shorter mean operative time (144 vs. 201 minutes; p < 0.001), a lower morbidity rate (3% vs. 22%; p = 0.043), and a shortened mean postoperative hospital stay (6.8 vs. 11.2 days; p = 0.011) than right hemicolectomy. There was no mortality in either group. In conclusion, most inflammatory cecal masses are due to benign pathologies and could be managed safely and sufficiently with ileocecal resection. Careful intraoperative assessment including examination of the resected specimen is essential to exclude malignancy, which would require right hemicolectomy.