Appendiceal Mass Nonoperative Management (Ochsner–Sherren Regimen)
The Ochsner–Sherren regimen is a nonoperative management strategy for appendiceal mass that uses initial hospitalization and close clinical monitoring with subsequent interval appendectomy in appropriate patients. [1]
Regimen Components
- Nil-per-os (bowel rest) with supportive care during the initial conservative treatment period. [1]
- Antibiotics with analgesics and intravenous fluids during the initial conservative treatment period. [1]
- Regular monitoring of clinical status by recording vital signs and abdominal exam findings, including assessment of change in the size of the mass. [1]
- If clinical improvement occurs, interval appendectomy is performed after resolution of the acute episode of appendiceal mass, typically at about 6 to 8 weeks after initial presentation. [2]
Appendiceal Abscess/Phlegmon Interval Appendectomy Nuance
For appendiceal abscess or phlegmon managed nonoperatively, routine interval appendectomy in an otherwise asymptomatic patient is conditionally recommended against by the Eastern Association for the Surgery of Trauma (EAST) practice management guideline. [3]
Mantrel (MANTRELS) Clinical Scoring System Diagnostic Performance
Sensitivity and Specificity
- Clinical assessment based on the MANTRELS criteria shows sensitivity of 91.6% and specificity of 84.7% for diagnosing acute appendicitis. [4]
Reference Values Source for MANTRELS Performance
The sensitivity and specificity values are reported from the study comparing clinical assessment using MANTRELS criteria versus computed tomography evaluation. [4]