A 28-year-old man with an appendicular mass is being managed conservatively (Ochsner-Sherren regimen). On day 3 of treatment he develops a rising pulse rate, increasing temperature, and the mass is enlarging with spreading tenderness. What is the correct next step?

• A Continue conservative management and add intravenous corticosteroids
• B Proceed to appendicectomy through the mass
• C Discharge home with oral antibiotics and review in 2 weeks
• D Abandon the conservative regimen and drain the abscess ✓

Explanation

Rising pulse and temperature with an enlarging, spreading mass indicate failure of the Ochsner-Sherren regimen and impending rupture, so the regimen must be abandoned and the abscess drained. Appendicectomy through an unprepared inflammatory mass risks injury to adherent ileum and caecum and should be avoided in this setting. Steroids have no role and discharge would be unsafe with clear progression.

Reference: Bailey and Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.