Inflammatory cecal masses in patients presenting with appendicitis

An unexpected inflammatory cecal mass of uncertain etiology encountered dur ing surgery for presumed appendicitis poses a dilemma to the surgeon when d eciding the appropriate operative management. A retrospective study was per formed to review the pathology and surgical management of this condition. A mong 3224 patients who had emergency surgery for a diagnosis of acute appen dicitis between January 1990 and December 1997, a group of 52 patients (1.6 %) underwent either ileocecal resection or right hemicolectomy for an infla mmatory cecal mass of uncertain etiology. The final pathologic diagnosis wa s cecal diverticulitis in 26 patients (50%), appendiceal phlegmon or absces s 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 hem icolectomy, including the 3 patients with cecal carcinoma. Ileocecal resect ion 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 shortene d mean postoperative hospital stay (6.8 vs. 11.2 days; p = 0.011) than righ t hemicolectomy. There was no mortality in either group. In conclusion, mos t inflammatory cecal masses are due to benign pathologies and could be mana ged safely and sufficiently with ileocecal resection. Careful intraoperativ e assessment including examination of the resected specimen is essential to exclude malignancy, which would require right hemicolectomy.