What is the Oschner Sherren regimen used for?

Ochsner-Sherren Regimen for Appendicular Lump Management

The Ochsner-Sherren regimen is a conservative management approach used for treating appendicular lump (mass) formation, which is a complication of delayed presentation of acute appendicitis. This regimen is the standard conservative treatment for patients who present with an appendicular mass 4-7 days after the onset of appendicitis symptoms 1.

Components of the Ochsner-Sherren Regimen

The regimen consists of:

1. Nil by mouth (NPO) - Restricting oral intake initially
2. Intravenous fluid administration - To maintain hydration and electrolyte balance
3. Intravenous antibiotics - Typically broad-spectrum to cover common pathogens
4. Regular monitoring of vital signs and abdominal examination
5. Interval appendectomy - Performed approximately 6-8 weeks after resolution of the inflammatory mass

Efficacy and Success Rate

Research shows that the Ochsner-Sherren regimen has a high success rate in managing appendicular lumps:

• Approximately 90.62% of patients successfully respond to conservative management 1
• Only about 9.37% of patients fail conservative treatment and require emergency surgery 1

When to Consider Surgical Intervention

Conservative management should be abandoned in favor of immediate surgical intervention if:

• General condition of the patient deteriorates
• Pain and tenderness do not subside
• Size of phlegmon or abscess increases
• Features of acute abdomen persist or worsen

Comparison with Early Surgical Intervention

Recent evidence suggests some advantages to early surgical intervention compared to the traditional Ochsner-Sherren approach:

• Shorter hospital stay: 91.66% of patients undergoing early appendectomy were discharged within 6 days versus only 25% in the conservative management group 1
• Eliminates the need for a second hospital admission for interval appendectomy
• Reduces total treatment time

Clinical Decision Making Algorithm

1. Diagnosis of appendicular lump:

   • Clinical examination revealing right iliac fossa mass
   • Supporting imaging (ultrasound/CT scan)
   • History of symptoms for 4-7 days

2. Patient assessment for Ochsner-Sherren regimen:

   • Stable vital signs
   • No signs of generalized peritonitis
   • No evidence of abscess requiring drainage

3. Implementation of conservative management:

   • NPO status
   • IV fluids
   • Broad-spectrum antibiotics (covering gram-negative and anaerobic organisms)
   • Regular monitoring (every 6 hours initially)

4. Monitoring response:

   • Improvement in symptoms within 24-48 hours
   • Reduction in size of mass
   • Normalization of inflammatory markers

5. Decision point at 48-72 hours:

   • If improving: continue conservative management
   • If worsening: proceed to emergency surgery

Considerations for Modern Practice

While the Ochsner-Sherren regimen remains a standard approach, clinicians should consider:

• Patient factors (age, comorbidities)
• Local surgical expertise and resources
• Patient preference regarding treatment options
• The potential benefit of shorter hospital stay with early surgical intervention

The traditional practice of obtaining peritoneal cultures during surgery for perforated appendicitis may be unnecessary, as studies show that in 98% of cases, the organisms identified were already sensitive to at least one of the empirically administered antibiotics 2.

Conclusion

The Ochsner-Sherren regimen remains an effective approach for managing appendicular lumps, with high success rates and relatively low morbidity. However, early surgical intervention may offer advantages in terms of shorter hospital stays and overall treatment duration. The decision between conservative and surgical management should be based on patient presentation, clinical judgment, and institutional resources.