World Journal of Surgery

, Volume 36, Issue 9, pp 2068–2073 | Cite as

Acute Appendicitis in a Developing Country

  • Victor Y. Kong
  • Bojana Bulajic
  • Nikki L. Allorto
  • Jonathan Handley
  • Damian L. Clarke



This prospective audit of appendicitis at a busy regional hospital reviews the spectrum and outcome of acute appendicitis in rural and peri-urban South Africa.


We conducted a prospective audit from September 2010 to September 2011 at Edendale Hospital in Pietermaritzburg, South Africa.


Over the year under review, a total of 200 patients with a provisional diagnosis of acute appendicitis were operated on at Edendale Hospital. There were 128 males (64 %) in this cohort. The mean duration of illness prior to seeking medical attention was 3.7 days. Surgical access was by a midline laparotomy in 62.5 % and by a Lanz incision in 35.5 %. Two percent of patients underwent a laparoscopic appendicectomy. The operative findings were as follows: macroscopic inflammation of the appendix without perforation in 35.5 % (71/200) and perforation of the appendix in 57 % (114/200). Of the perforated appendices, 44 % (51/114) were associated with localised intra-abdominal contamination and 55 % (63/114) had generalised four-quadrant soiling. Thirty percent (60/200) required temporary abdominal closure (TAC) with planned repeat operation. Major complications included hospital-acquired pneumonia in 12.5 % (25/200), wound dehiscence in 7 % (14/200), and renal failure in 3 % (6/200). Postoperatively 89.5 % (179/200) were admitted directly to the general wards, while 11 % (21/200) required admission to the intensive care unit. The overall mortality rate was 2 % (4/200).


The incidence of acute appendicitis amongst African patients seems to be increasing. Although it is still lower than the reported incidence amongst patients in the developed world, it is a common emergency that places a significant burden on the South African health service. The disease presents late and is associated with a high incidence of perforation which translates into significant morbidity and even mortality.


Appendicitis Intensive Care Unit Admission Acute Appendicitis Laparoscopic Appendicectomy Pelvic Inflammatory Disease 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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Copyright information

© Société Internationale de Chirurgie 2012

Authors and Affiliations

  • Victor Y. Kong
    • 2
  • Bojana Bulajic
    • 2
  • Nikki L. Allorto
    • 2
  • Jonathan Handley
    • 1
  • Damian L. Clarke
    • 2
  1. 1.Department of AnesthesiologyEdendale Hospital, Pietermaritzburg Metropolitan Hospitals ComplexPietermaritzburgSouth Africa
  2. 2.Department of General SurgeryNelson R. Mandela School of Medicine, University of Kwa-Zulu NatalDurbanSouth Africa

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