A patient with an appendicular mass is being managed conservatively on the Ochsner-Sherren regimen. Which finding during observation mandates abandonment of conservative treatment and immediate surgery?

• A Persistent low-grade pyrexia below 38 degrees Celsius
• B Decreasing size of the mass after 5 days of therapy
• C Resolution of tachycardia over the first 48 hours
• D Increasing size of the palpable mass with spreading tenderness and a rising pulse rate ✓

Explanation

The Ochsner-Sherren conservative regimen is abandoned if there is evidence of progression: a rising pulse rate, increasing or spreading tenderness, enlargement of the mass, increasing temperature, or appearance of features of generalised peritonitis. These indicate an enlarging abscess or free perforation requiring intervention. Falling temperature, falling pulse, and a shrinking mass are all expected markers of successful resolution and are indications to continue the regimen.

Reference: Bailey and Love's Short Practice of Surgery, 28th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.