Acute appendicitis in a developing country

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.