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Oshner sherrif regimen

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Ochsner Sherren regimen appendicular mass management

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Ochsner-Sherren regimen is conservative, non-operative treatment for a localized appendicular mass (phlegmon) or appendicular abscess in a clinically stable patient.

Regimen

  • Admit and keep nil by mouth
  • IV fluids and correct electrolytes
  • IV broad-spectrum antibiotics covering enteric Gram-negative and anaerobic organisms
  • Analgesia and antiemetics as needed
  • Close observation
    • Temperature and pulse every 4 hours
    • Fluid-input/output chart
    • Serial abdominal examination
    • Mark and measure the palpable mass daily
    • Monitor CBC/inflammatory markers as appropriate
  • Contrast CT to define a mass or abscess
  • If a drainable abscess is present: image-guided percutaneous drainage
  • Advance diet once pain, fever, tenderness, and inflammatory markers improve.

When to abandon conservative treatment and operate

  • Rising pulse or persistent/worsening fever
  • Increasing, spreading pain or tenderness
  • Enlarging mass
  • Generalized peritonitis
  • Sepsis, obstruction, or clinical deterioration
  • No clear improvement within about 24-48 hours
The rationale is that operating through an established inflammatory mass may be difficult and can cause bowel injury or fistula. Bailey & Love describes conservative treatment for a satisfactory, stable patient, with surgery if deterioration occurs; it also advises CT, antibiotics, drainage of an abscess, and 4-hourly pulse/temperature monitoring. Bailey and Love's Short Practice of Surgery, 28th ed., Appendix mass section.
Interval appendicectomy after resolution is no longer automatic for every patient. It is individualized, particularly if symptoms recur, imaging is suspicious, or the patient is older than 40 years, where exclusion of appendiceal/caecal neoplasm matters. The 2024 SAGES appendicitis guideline reflects the current evidence-based approach.
This is not suitable for an unstable patient or one with diffuse peritonitis.
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