Advertisement

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
Article

Abstract

Background

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.

Method

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

Results

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).

Conclusions

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.

Keywords

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.

References

  1. 1.
    Heaton KW (1987) Aetiology of acute appendicitis. Br J Surg 294:1632–1633Google Scholar
  2. 2.
    Walker AR, Segal I (1995) Appendicitis: an African perspective. J R Soc Med 88:616–619PubMedGoogle Scholar
  3. 3.
    Levy RD, Degiannis E, Kantarovsky A et al (1997) Audit of acute appendicitis in a black South African population. S Afr J Surg 35(4):198–202PubMedGoogle Scholar
  4. 4.
    Walker AR, Shipton E, Walker BF, Manetsi B, Van Rensburg PS, Vorster HH (1989) Appendicectomy incidence in black and white children aged 0–14 years with a discussion on the disease’s causation. Trop Gastroenterol 10(2):96–101PubMedGoogle Scholar
  5. 5.
    Fulton J, Lazarus C (1995) Acute appendicitis among black South Africans. S Afr J Surg 33(4):165–166PubMedGoogle Scholar
  6. 6.
    Muthuphei MN, Morwamoche P (1998) The surgical pathology of the appendix in South African blacks. Cent Afr J Med 44(1):9–11PubMedGoogle Scholar
  7. 7.
    Madiba TE, Haffejee AA, Mbete DL, Chaithram H, John J (1998) Appendicitis among African patients at King Edward VIII Hospital, Durban, South Africa: a review. East Afr Med J 75(2):81–84PubMedGoogle Scholar
  8. 8.
    Walker AR, Richardson BD, Walker BF, Woolford A (1973) Appendicitis, fibre intake and bowel behaviour in ethnic groups in South Africa. Postgrad Med J 49(570):243–249PubMedCrossRefGoogle Scholar
  9. 9.
    Walker AR, Segal I (1997) Effects of transition on bowel diseases in sub-Saharan Africans. Eur J Gastroenterol Hepatol 9(2):207–210PubMedCrossRefGoogle Scholar
  10. 10.
    Lane MJ, Liu DM, Huynh MD, Jeffrey RB Jr, Mindelzun RE, Katz DS (1999) Suspected acute appendicitis: nonenhanced helical CT in 300 consecutive patients. Radiology 213(2):341–346PubMedGoogle Scholar
  11. 11.
    Mason RJ (2008) Surgery for appendicitis: is it necessary? Surg Infect (Larchmt) 9(4):481–488CrossRefGoogle Scholar
  12. 12.
    Hansson J, Körner U, Khorram-Manesh A, Solberg A, Lundholm K (2009) Randomized clinical trial of antibiotic therapy versus appendicectomy as primary treatment of acute appendicitis in unselected patients. Br J Surg 96(5):473–481PubMedCrossRefGoogle Scholar
  13. 13.
    Abes M, Petik B, Kazil S (2007) Non-operative treatment of acute appendicitisin children. J Pediatr Surg 42:1439–1442PubMedCrossRefGoogle Scholar
  14. 14.
    Ayoade BA, Olawoye OA, Salami BA, Banjo AAF (2006) Acute appendicitis in Olabisi Onabanjo University Teaching Hospital Sagamu, a three year review. Niger J Clin Pract 9(1):52–64PubMedGoogle Scholar
  15. 15.
    Willmore WS, Hill AG (2001) Acute appendicitis in a Kenyan rural hospital. East Afr Med J 78(7):355–357PubMedGoogle Scholar
  16. 16.
    Walker AR, Walker BF, Manetsi B, Tsotetsi NG, Segal I (1989) Appendicitis in Soweto, South Africa. Traditional healers and hospitalization. J R Soc Health 109:190–192PubMedCrossRefGoogle Scholar
  17. 17.
    Rogers AD, Hampton MI, Bunting M, Atherstone AK (2008) Audit of appendicectomies at Frere Hospital, Eastern Cape. S Afr J Surg 46(3):74–77PubMedGoogle Scholar
  18. 18.
    Ohene-Yeboah M, Togbe B (2006) An audit of appendicitis and appendicectomy in Kumasi, Ghana. West Afr J Med 25(2):138–143PubMedGoogle Scholar
  19. 19.
    Zoguéreh DD, Lemaître X, Ikoli JF, Delmont J, Chamlian A, Mandaba JL, Nali NM (2001) Acute appendicitis at the National University Hospital in Bangui, Central African Republic: epidemiologic, clinical, paraclinical and therapeutic aspects. Sante 11(2):117–125PubMedGoogle Scholar
  20. 20.
    Chamisa I (2009) A clinicopathological review of 324 appendices removed for acute appendicitis in Durban, South Africa: a retrospective analysis. Ann R Coll Surg Engl 91(8):688–692PubMedCrossRefGoogle Scholar
  21. 21.
    McCartan DP, Fleming FJ, Grace PA (2010) The management of right iliac fossa pain—is timing everything? Surgeon 8(4):211–217PubMedCrossRefGoogle Scholar
  22. 22.
    Omundsen M, Dennett E (2006) Delay due to appendicectomy and associated morbidity: a retrospective review. ANZ J Surg 76(3):153–155PubMedCrossRefGoogle Scholar
  23. 23.
    Hale DA, Molloy M, Pearl RH, Schutt DC, Jaques DP (1995) Appendectomy—a contemporary appraisal. Ann Surg 225(3):252–261CrossRefGoogle Scholar
  24. 24.
    Ramesh S, Galland RB (1993) Early discharge from hospital after open appendicectomy. Br J Surg 80:1192–1193PubMedCrossRefGoogle Scholar
  25. 25.
    Colson M, Skinner KA, Dunnington G (1997) High negative appendectomy rates are no longer acceptable. Am J Surg 174:723–726PubMedCrossRefGoogle Scholar
  26. 26.
    Temple CL, Huchcroft SA, Temple WJ (1995) The natural history of appendicitis in adults. A prospective study. Ann Surg 221(3):278–281PubMedCrossRefGoogle Scholar
  27. 27.
    Papaziogas B, Tsiaousis P, Koutelidakis I et al (2009) Effect of time on risk of perforation in acute appendicitis. Acta Chir Belg 109:75–80PubMedGoogle Scholar
  28. 28.
    Bickell NA, Aufses AH Jr, Rojas M, Bodian C (2006) How time affects the risk of rupture in appendicitis. J Am Coll Surg 202:401–406PubMedCrossRefGoogle Scholar
  29. 29.
    Yardeni D, Hirschl RB, Drongowski RA, Teitelbaum DH, Geiger JD, Coran AG (2004) Delayed vs immediate surgery in acute appendicitis: do we need to operate during the night? J Pediatr Surg 39:464–469PubMedCrossRefGoogle Scholar
  30. 30.
    Abou-Nukta F, Bakhos C, Arroyo K et al (2006) Effects of delaying appendectomy for acute appendicitis for 12 to 24 hours. Arch Surg 141(5):504–506PubMedCrossRefGoogle Scholar
  31. 31.
    Augustin T, Cagir B, Vandermeer TJ (2011) Characteristics of perforated appendicitis: effect of delay is confounded by age and gender. J Gastrointest Surg 15(7):1223–1231PubMedCrossRefGoogle Scholar
  32. 32.
    Styrud J, Eriksson S, Nilsson I et al (2006) Appendectomy versus antibiotic treatment in acute appendicitis. A prospective multicenter randomized controlled trial. World J Surg 30:1033e7. doi: 10.1007/s00268-005-0304-6 CrossRefGoogle Scholar
  33. 33.
    Liu K, Fogg L (2011) Use of antibiotics alone for treatment of uncomplicated acute appendicitis: a systematic review and meta-analysis. Surgery 150(4):673–683PubMedCrossRefGoogle Scholar
  34. 34.
    Dunn EL, Moore EE, Elerding SC, Murphy JR (1982) The unnecessary laparotomy for appendicitis—can it be decreased? Am Surg 48(7):320–323PubMedGoogle Scholar
  35. 35.
    Clarke DL, Thomson SR, Bissetty T et al (2007) A single surgical unit’s experience with abdominal tuberculosis in the HIV/AIDS era. World J Surg 31(5):1087–1096. doi: 10.1007/s00268-007-0402-8 discussion 1097–1098PubMedCrossRefGoogle Scholar
  36. 36.
    Ghimenton F, Thomson SR, Muckart DJ, Burrows R (2000) Abdominal content containment: practicalities and outcome. Br J Surg 87(1):106–109PubMedCrossRefGoogle Scholar
  37. 37.
    Lamme B, Boermeester MA, Reitsma JB et al (2002) Meta-analysis of relaparotomy for secondary peritonitis. Br J Surg 89(12):1516–1524PubMedCrossRefGoogle Scholar
  38. 38.
    Van Ruler O, Mahler CW, Boer KR et al (2007) Comparison of on-demand vs planned relaparotomy strategy in patients with severe peritonitis: a randomized trial. JAMA 298(8):865–872PubMedCrossRefGoogle Scholar

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

Personalised recommendations