Skip to main content

Advertisement

SpringerLink
Log in

Acute Appendicitis in a Developing Country

  • Published:
World Journal of Surgery Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Heaton KW (1987) Aetiology of acute appendicitis. Br J Surg 294:1632–1633

    CAS  Google Scholar 

  2. Walker AR, Segal I (1995) Appendicitis: an African perspective. J R Soc Med 88:616–619

    PubMed  CAS  Google Scholar 

  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):198–202

    PubMed  CAS  Google Scholar 

  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):96–101

    PubMed  CAS  Google Scholar 

  5. Fulton J, Lazarus C (1995) Acute appendicitis among black South Africans. S Afr J Surg 33(4):165–166

    PubMed  CAS  Google Scholar 

  6. Muthuphei MN, Morwamoche P (1998) The surgical pathology of the appendix in South African blacks. Cent Afr J Med 44(1):9–11

    PubMed  CAS  Google Scholar 

  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):81–84

    PubMed  CAS  Google Scholar 

  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):243–249

    Article  PubMed  CAS  Google Scholar 

  9. Walker AR, Segal I (1997) Effects of transition on bowel diseases in sub-Saharan Africans. Eur J Gastroenterol Hepatol 9(2):207–210

    Article  PubMed  CAS  Google Scholar 

  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):341–346

    PubMed  CAS  Google Scholar 

  11. Mason RJ (2008) Surgery for appendicitis: is it necessary? Surg Infect (Larchmt) 9(4):481–488

    Article  Google Scholar 

  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):473–481

    Article  PubMed  CAS  Google Scholar 

  13. Abes M, Petik B, Kazil S (2007) Non-operative treatment of acute appendicitisin children. J Pediatr Surg 42:1439–1442

    Article  PubMed  Google Scholar 

  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):52–64

    PubMed  CAS  Google Scholar 

  15. Willmore WS, Hill AG (2001) Acute appendicitis in a Kenyan rural hospital. East Afr Med J 78(7):355–357

    PubMed  CAS  Google Scholar 

  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 109:190–192

    Article  PubMed  CAS  Google Scholar 

  17. Rogers AD, Hampton MI, Bunting M, Atherstone AK (2008) Audit of appendicectomies at Frere Hospital, Eastern Cape. S Afr J Surg 46(3):74–77

    PubMed  CAS  Google Scholar 

  18. Ohene-Yeboah M, Togbe B (2006) An audit of appendicitis and appendicectomy in Kumasi, Ghana. West Afr J Med 25(2):138–143

    PubMed  Google Scholar 

  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):117–125

    PubMed  Google Scholar 

  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):688–692

    Article  PubMed  CAS  Google Scholar 

  21. McCartan DP, Fleming FJ, Grace PA (2010) The management of right iliac fossa pain—is timing everything? Surgeon 8(4):211–217

    Article  PubMed  CAS  Google Scholar 

  22. Omundsen M, Dennett E (2006) Delay due to appendicectomy and associated morbidity: a retrospective review. ANZ J Surg 76(3):153–155

    Article  PubMed  Google Scholar 

  23. Hale DA, Molloy M, Pearl RH, Schutt DC, Jaques DP (1995) Appendectomy—a contemporary appraisal. Ann Surg 225(3):252–261

    Article  Google Scholar 

  24. Ramesh S, Galland RB (1993) Early discharge from hospital after open appendicectomy. Br J Surg 80:1192–1193

    Article  PubMed  CAS  Google Scholar 

  25. Colson M, Skinner KA, Dunnington G (1997) High negative appendectomy rates are no longer acceptable. Am J Surg 174:723–726

    Article  PubMed  CAS  Google Scholar 

  26. Temple CL, Huchcroft SA, Temple WJ (1995) The natural history of appendicitis in adults. A prospective study. Ann Surg 221(3):278–281

    Article  PubMed  CAS  Google Scholar 

  27. Papaziogas B, Tsiaousis P, Koutelidakis I et al (2009) Effect of time on risk of perforation in acute appendicitis. Acta Chir Belg 109:75–80

    PubMed  CAS  Google Scholar 

  28. Bickell NA, Aufses AH Jr, Rojas M, Bodian C (2006) How time affects the risk of rupture in appendicitis. J Am Coll Surg 202:401–406

    Article  PubMed  Google Scholar 

  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 39:464–469

    Article  PubMed  Google Scholar 

  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):504–506

    Article  PubMed  Google Scholar 

  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):1223–1231

    Article  PubMed  Google Scholar 

  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

    Article  Google Scholar 

  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):673–683

    Article  PubMed  Google Scholar 

  34. Dunn EL, Moore EE, Elerding SC, Murphy JR (1982) The unnecessary laparotomy for appendicitis—can it be decreased? Am Surg 48(7):320–323

    PubMed  CAS  Google Scholar 

  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 1097–1098

    Article  PubMed  CAS  Google Scholar 

  36. Ghimenton F, Thomson SR, Muckart DJ, Burrows R (2000) Abdominal content containment: practicalities and outcome. Br J Surg 87(1):106–109

    Article  PubMed  CAS  Google Scholar 

  37. Lamme B, Boermeester MA, Reitsma JB et al (2002) Meta-analysis of relaparotomy for secondary peritonitis. Br J Surg 89(12):1516–1524

    Article  PubMed  CAS  Google Scholar 

  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):865–872

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anesthesiology, Edendale Hospital, Pietermaritzburg Metropolitan Hospitals Complex, Pietermaritzburg, South Africa

    Jonathan Handley

  2. Department of General Surgery, Nelson R. Mandela School of Medicine, University of Kwa-Zulu Natal, Durban, South Africa

    Victor Y. Kong, Bojana Bulajic, Nikki L. Allorto & Damian L. Clarke

Authors
  1. Victor Y. Kong
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bojana Bulajic
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Nikki L. Allorto
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jonathan Handley
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Damian L. Clarke
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Damian L. Clarke.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Kong, V.Y., Bulajic, B., Allorto, N.L. et al. Acute Appendicitis in a Developing Country. World J Surg 36, 2068–2073 (2012). https://doi.org/10.1007/s00268-012-1626-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-012-1626-9

Keywords

Search

Navigation