Appendicitis and its surgical management experience at the University of Maiduguri Teaching Hospital Nigeria

Abstract

Background: Acute appendicitis and its complications is still the most common cause of acute abdominal pain that will require surgical intervention in most parts of the West African sub-region. This study is a review of our management and outcome of acute appendicitis in the University of Maiduguri Teaching Hospital [UMTH].

Method: A retrospective and prospective audit of all patients with acute appendicitis seen and managed over an 8- year period [2002-2009 inclusive] in the UMTH is presented. Materials used included patients demographic variables, clinical presentation, laboratory data, operative findings and treatment outcome.

Results: One thousand two hundred and fifty-seven patients were studied. These were 426 (33.9%) males and 831 (66.1%) females; a male to female ratio of 1:2. The mean age was 32.4 15.0 years. All the patients were admitted with abdominal pain that was initially located at the right iliac fossa in 480 (38.2%), periumbilical in 393 (31.3%) and diffused in 351(27.9%) patients. Vomiting 85.7%, fever 73.0% and anorexia 49.0% were the most frequent symptoms. The mean duration of illness was 72 hours. Right iliac fossa pain and tenderness were present in 1112 (88.46%) patients. The total white cell count was significantly raised (p < 0.05). All the patients had appendicectomy, 295 (23.47%) of the appendices were perforated at operation and 200 (15.9%) of the removed appendices had no histological evidence of inflammation. The complication rate was 36.2% and wound infection (28.30%) was the most common. The mean hospital stay was 3 days. There were 12 deaths; a mortality rate of 0.9%; mostly patients with ruptured appendix and peritonitis.

Conclusion: The diagnosis of appendicitis is clinical and supported by a raised total white cell count with neutrophilia. The negative appendicectomy rate of 15.9% falls below the range reported in other studies. More than a fifth of the appendices were perforated and mortality was low.