title: Treatment of appendiceal mass--a qualitative systematic review.
abstract: BACKGROUND
  The treatment strategy for appendiceal mass is controversial, ranging from operation or image-guided drainage to conservative treatment with or without antibiotics. The aim of this study was to assess the various treatment modalities with respect to complications and treatment failure.
  
  
  METHODS
  The analysis was based on the principles of a qualitative systematic review. The literature was searched in PubMed for the period from 1966 to March 2014. The articles were reviewed with respect to complications, treatment failure and hospital stay. Papers on post-operative intra-abdominal abscesses and abscesses of any cause other than appendicitis were excluded as were also studies only describing recurrent appendicitis and/or interval appendectomy. Sub-analyses were performed in children, adults, and in mixed populations.
  
  
  RESULTS
  A total of 48 studies were found eligible; they included in total 3,772 patients. Operation for appendiceal mass was beset with a moderate to high risk of complications of up to 57% and a risk of intestinal resection of up to 25%. Major complications were observed in up to 18% of cases. Conservative treatment with or without antibiotics was associated with a treatment failure rate of 8-15%. Drainage was beset with a risk of complications of 2-15% and a risk of treatment failure of 2-13%.
  
  
  CONCLUSIONS
  Operation with appendectomy for appendiceal mass carries a high risk of complications compared with conservative treatment or drainage. Drainage may lower the risk of treatment failure but entails a risk of complications. Based on the best evidence, we propose a step-down treatment strategy.
  
  
  BACKGROUND
  Not relevant.
  
  
  BACKGROUND
  Not relevant.
authors.affiliation: Ny Carlsbergvej 19, 2. th., 1760 København V, Denmark. josn@regionsjaelland.dk.
authors.forename: Jesper
authors.initials: J
authors.lastname: Olsen
authors.forename: Jan
authors.initials: J
authors.lastname: Skovdal
authors.forename: Niels
authors.initials: N
authors.lastname: Qvist
authors.forename: Thue
authors.initials: T
authors.lastname: Bisgaard
mesh_terms: D018784:Abdominal Abscess / Q000175:diagnosis / Q000628:therapy*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001062:Appendectomy / Q000009:adverse effects; D001064:Appendicitis / Q000175:diagnosis / Q000628:therapy*; D004322:Drainage / Q000009:adverse effects; D006801:Humans; D017211:Treatment Failure; D057832:Watchful Waiting
chemical_list: D000900:Anti-Bacterial Agents