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An appendicular mass is a complication of appendicitis. It is usually seen in the cases where appendicitis is left untreated or undiagnosed. It may also develop if appendicular surgery is delayed. This article will discuss appendicular mass in detail.

An appendicular mass may be defined as a grouping of inflamed tissue in the right lower quadrant. This mass, which affects the inflamed appendix as well as the tissues around it, is one of the possible complications of untreated or undiagnosed appendicitis. It usually surrounds an intensely inflamed or ruptured appendix.

What is the Appendix?

The appendix is an approximately 3.5 inch long worm-shaped tube of tissue. It projects from the first part of the large intestine (colon), and extends from the lower right part of the abdomen. [1] The appendix is unique in that it has no known function in digestion or otherwise, and we can therefore easily survive without it.

However, an infection of the appendix can have serious consequences and can even be life-threatening. This explains why surgeons are quick to recommend its removal at the first sign of trouble.

What is Appendicitis?

Appendicitis is defined as an inflammation or swelling of the inner lining of the appendix. This inflammation, which is not uncommon, may spread to other parts of the intestine as well. Despite medical advancements, appendicitis is still regarded as a medical emergency requiring immediate surgery. [1]

What is an Appendicular Mass?

Appendicular mass is a formation of tissue in the right iliac fossa, around the appendix, due to an untreated appendix infection or appendicular abscess. It is an inflammatory but benign tumor found in and around an already inflamed appendix, which contains pus.

Appendicitis is a common disorder found in young patients worldwide. The diagnosis of appendicitis is made on a clinical basis according to the presenting complains. Lab tests are not considered reliable. However, these tests are found to be very helpful in making the correct diagnosis. Most of the patients with appendicitis present in an emergency department with severe pain in the right lower quadrant of the abdomen. Because of the severe pain, surgeons do not have much time to wait for the laboratory tests and the diagnosis is made on a clinical basis.

Appendicitis can also present with complains that are not typically associated with appendicitis. The patient may complain of pain on both sides of the lower abdomen rather than in the right region only. A patient may have no fever, which makes the diagnosis of appendicitis questionable. Keeping in mind all these conditions, surgeons now perform an appendectomy (removal of the inflamed appendix) prophylactically, meaning as a routine precaution even if they are not sure whether the patient indeed has appendicitis. [2]

According to some reports, 50% of appendicular surgeries worldwide will later prove to be of a purely precautionary nature, as there was no problem in appendix. [3]

But still, a surgeon who performs an appendectomy on the grounds of a suspicion is considered to be a good surgeon. This is because undiagnosed appendicitis is like a time bomb which can rupture any time, risking a patient’s life. Ruptured appendicitis can even lead to death.

How does Appendicitis lead to an Appendicular Mass?

An appendicular mass is a rare complication in developed countries. It is usually seen in developing nations or third world countries where people are reluctant to have surgery. There are certain factors that lead to the formation of an appendicular mass. Some of the most common reasons why people develop appendicular mass include [4]:

  • An undiagnosed appendicular infection
  • Delayed diagnosis of appendicitis
  • Appendicitis in patients with diabetes: If a patient has developed diabetic neuropathy, he may not feel very severe pain as a result of which appendicitis may be misdiagnosed.
  • Poverty: Lack of money for surgery
  • Fear of surgery
  • Patients in rural areas: General physicians usually keep the patient on painkillers instead of referring a risky patient to high level hospital    
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