Is Interval Appendectomy Necessary for Appendicular Phlegmon? A Prospective Study

  • Mohammad Reza Motie
  • Ali Ahmadabadi
  • Mohammad Vejdani
  • Alireza Rezapanah
  • Majid Khadem Rezaiyan
  • Mohammad Naser Shafiee
  • Armin Mahdiani
Original Article


Appendectomy is accepted as the standard treatment of acute appendicitis, but in complicated cases, the treatment of choice is not straightforward. In this prospective study, we compared failure rate, complications, and recurrence rate of three different approaches to complicated appendicitis. In a 5-year prospective cohort study, patients with appendicular phlegmon were studied in three groups based on the treatment protocols. Group A included patients who underwent an appendectomy; patients of group B were treated by interval appendectomy; and in group C, conservative management was performed without interval appendectomy. Data analysis was performed using SPSS version 11.5. In total, 3896 patients with acute appendicitis were admitted, and 127 patients with complicated appendicitis were treated. Fifty-four patients were excluded from the study. Differences in age, gender, weight, and duration of symptoms were not statistically significant in the three groups. In group A (N = 23), appendectomy was impossible in 4 patients and 5 patients experienced complications. In group B (N = 24), two patients underwent exploration and appendectomy. In another two patients, a recurrent episode of acute appendicitis with mild signs and symptoms occurred after discharge from the hospital. In group C (N = 25), three patients experienced a recurrent appendicitis. Interval appendectomy is not indicated in all patients and continuous non-operative management may be appropriate in some patients. As the epidemiology of colorectal cancer and inflammatory bowel diseases is different in Iran, we recommend other researchers to perform a cost-effectiveness analysis on colon and appendicular neoplasms workup after non-operative management of complicated appendicitis.


Appendicitis Complications Phlegmon Interval appendectomy 


CT scan

Computed tomography


Standard deviation

WBC count

White blood cell



The results described in this paper are part of a thesis submitted by the third author for a postgraduate degree in general surgery. The study was supported by the Vice Chancellor for Research of Mashhad University of Medical Sciences (Grant No. 89007). The authors gratefully acknowledge the contribution of Ms. M. Hassanpour in editing the manuscript.

Authors’ Contributions

Conception and design: Mohammad Reza Motie, Mohammad Vejdani, and Ali Ahmadabadi

Analysis/interpretation: Ali Ahmadabadi, Majid Khadem Rezaiyan, Alireza Rezapanah, and Mohammad Reza Motie

Data collection: Mohammad Vejdani, Mohammad Reza Motie, Ali Ahmadabadi, and Armin Mahdiani

Writing the article: Ali Ahmadabadi, Mohammad Naser Shafiee, Majid Khadem Rezaiyan, and Alireza Rezapanah

Critical revision: Mohammad Reza Motie, Mohammad Naser Shafiee, Ali Ahmadabadi, and Majid Khadem Rezaiyan

Final approval: Mohammad Reza Motie, Ali Ahmadabadi, Mohammad Vejdani, Alireza Rezapanah, Majid Khadem Rezaiyan, Mohammad Naser Shafiee, and Armin Mahdiani

Statistical analysis: Majid Khadem Rezaiyan

Obtained funding: Mohammad Reza Motie

Overall responsibility: Mohammad Reza Motie, Mohammad Vejdani, and Ali Ahmadabadi

Compliance with Ethical Standards

Ethics statement

This prospective cohort study was approved by the ethics committee of Mashhad University of Medical Sciences, Iran. An informed consent was obtained before recruiting for the study.

Conflicts of Interest

The authors declare that they have no conflict of interest.


This study was supported by the Vice Chancellor for Research of Mashhad University of Medical Sciences.


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Copyright information

© Association of Surgeons of India 2017

Authors and Affiliations

  • Mohammad Reza Motie
    • 1
  • Ali Ahmadabadi
    • 1
  • Mohammad Vejdani
    • 2
  • Alireza Rezapanah
    • 3
  • Majid Khadem Rezaiyan
    • 4
  • Mohammad Naser Shafiee
    • 5
  • Armin Mahdiani
    • 6
  1. 1.Surgical Oncology Research CenterMashhad University of Medical SciencesMashhadIran
  2. 2.Mashhad University of Medical SciencesMashhadIran
  3. 3.Department of Surgery, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
  4. 4.Student Research Committee, Department of Community Medicine and Public Health, Faculty of MedicineMashhad University of Medical SciencesMashhadIran
  5. 5.English Department, Faculty of MedicineMashhad university of Medical SciencesMashhadIran
  6. 6.Faculty of MedicineHormozgan University of Medical SciencesBandar AbbasIran

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