Plastron appendiculaire: intervention en urgence ou différée: à propos d’une série de 27 cas dans la clinique chirurgicale de l’Hôpital Aristide Le Dantec

Our study aimed to evaluate the outcome of the surgical treatment of appendicular plastron after deferred or emergency appendectomy. We conducted a retrospective, descriptive study of 27 patients treated for appendicular plastron from January 2000 to 31 December 2007. Diagnosis was based on clinical examination showing a mass in the right iliac fossa, on ultrasound or made intraoperatively. All patients undergoing emergency surgery were classified in Group I while those undergoing deferred surgery were classified in Group II. 18 men and 9 women were registered, with a sex-ratio man /Woman=2. The average age of patients was 33 years, ranging between 19 and 57 years. Clinical signs were dominated by pain in the right iliac fossa and fever in 25(92.6%) and 15 (55.6%) of cases respectively. In group I, appendectomy couldn’t be performed in 7 cases (n= 15) due to surgical complications. In all other cases appendectomy was performed by enlarging Mac Burney’s incision and was associated with longer length of stay in hospital. Group II included 12 patients (n=12), 9 underwent laparoscopy and 3 patients underwent Mac Burney’s incision. 3 cases with peritoneal adhesions were detected during coelioscopy. Deferred appendectomy of appendicular plastron is a safe and efficient surgical procedure. It allows to avoid unattractive scarrings and iatrogenic digestive fistulas. Emergency appendectomy shouldn’t be performed in patients with appendicular plastron because it increases the risks of morbidity.