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Session: ePoster: Other Neoplasia and Endoscopy 7 (Tue8)

EP960 - Unveiling the Hidden Danger: Risk of Appendiceal Malignancy in Non-Operative Management of Patients Presenting with Appendiceal Mass

Tuesday, May 13, 2025
8:32 AM – 8:37 AM PT

    ePoster Presenter(s)

  • HA

    Hadeel Alhamly, MD

    General Surgery Resident
    Ministry of Health
    Kuwait City, Al Farwaniyah, Kuwait

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Author(s)

  • AA

    Abrar Abdulwahab AlAtwan, MD

    General Surgery Resident
    Ministry Of Health
    Kuwait City, Al Asimah, Kuwait

    Disclosure information not submitted.

  • Abdullah Alnaqeeb, MD

    assistant registrar
    Ministry of health - mubarak hospital - kuwait
    kuwait city, Mubarak al Kabir, Kuwait

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

  • Ammar Saleem, MD

    Assistant Registrar - General Surgery
    Mubarak Alkabeer Hospital, Kuwait
    Shaab, Hawalli, Kuwait

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

  • JA

    Jasim Alabbad, MD, FACS, FRCSC

    Associate Professor
    Kuwait University
    Kuwait City, Hawalli, Kuwait

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

    • Senior Author(s)

  • FA

    Fawaz Alnaqi, MD, MPH, FACS, FRCSC

    Assistant Professor
    College of Medicine, Kuwait University
    Kuwait city, Al Asimah, Kuwait

    All of the relevant financial relationships listed below have been mitigated.
    This individual has no financial relationships with ineligible companies.

All of the relevant financial relationships listed below have been mitigated.
Hadeel Alhamly, MD: This individual has no financial relationships with ineligible companies.
Abdullah Alnaqeeb, MD: This individual has no financial relationships with ineligible companies.
Ammar Saleem, MD: This individual has no financial relationships with ineligible companies.
Jasim Alabbad, MD, FACS, FRCSC: This individual has no financial relationships with ineligible companies.
Fawaz Alnaqi, MD, MPH, FACS, FRCSC: This individual has no financial relationships with ineligible companies.
Image or Table (Do Not add text here):

Purpose/Background: Approximately 2-6% of patients with acute appendicitis present with an appendiceal mass. Non-operative management (NOM) of an appendiceal mass has been demonstrated to be safe and efficacious. The necessity of performing an appendectomy following successful NOM remains debatable given the low rate of symptom recurrence. Advocates for this approach emphasize the risk of an underlying appendiceal neoplasm in adults. This study aims to determine the incidence of malignancy in patients undergoing interval appendectomy following successful NOM of an appendiceal mass within a consecutive cohort.

Methods/Interventions: Following institutional review board approval, a retrospective chart review was conducted for all adults patients (age ≥ 18) who underwent interval appendectomy following NOM of an appendiceal mass between May 2006 and September 2024 at a university-affiliated government hospital in Kuwait. Appendiceal mass was defined by computed tomography at the time of presentation as appendicitis complicated by a walled off perforation of the appendix, resulting in an appendiceal phlegmon or an appendiceal abscess. Interval appendectomy was defined as an elective appendectomy performed after at least 6 weeks following successful NOM of appendicular mass. Demographic, clinical, perioperative, and pathologic characteristics were collected and analyzed.

Results/Outcomes: A total of 33 patients met the inclusion criteria between May 2006 and September 2024. The mean age at the time of surgery was 42.2 (± 11.7) years, with 54.5% being male. Diagnostic imaging at presentation revealed the following: 11 patients had an abscess, and 23 had a phlegmon. All patients were admitted and treated with antibiotic therapy. Of the patients with an abscess, 10 required percutaneous drainage. Preoperative colonoscopy did not identify any malignancies. The average duration from diagnosis of appendicitis to operative intervention was 15.4 (± 9.8) weeks. Pathological examination following interval appendectomy identified 7 appendiceal malignancies, resulting in an overall malignancy rate of 21.2%. No malignancy was identified in any patient under the age of 45 years. There were no mortalities or hospital readmissions. One patient experienced a stroke (Clavien-Dindo classification grade IV).

Conclusion/Discussion: Interval appendectomies is a low-risk procedure and carries a significant potential for treating malignancy following NOM of an appendiceal mass. In this cohort, the incidence of malignancy in patients undergoing interval appendectomy was 21.2%. This finding underscores the importance of vigilant postoperative monitoring and the consideration of malignancy in NOM of an appendiceal mass in adult patients.