Acute Appendicitis—we thought we knew it all?

Leppäniemi, Ari

doi:10.1177/1457496914525695

Scand J Surg

2014

DOI: 10.1177/1457496914525695

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Acute Appendicitis—we thought we knew it all?

Ari Leppäniemi¹

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“…2,3 There has been renewed interest in this condition in both the developed and the developing world. 4 In the developed world, the focus of research has been on the role of advanced imagining, non-operative management and the benefits of laparoscopic appendicectomy. 5 However, the available literature shows that appendicitis in the developing world has a very different profile, which is associated with significant morbidity and even mortality.…”

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Acute appendicitis in the developing world is a morbid disease

Kong

Sartorius

Clarke

2015

annals

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INTRODUCTION Acute appendicitis in the developing world has a markedly different disease profile to that in the developed world. METHODS A retrospective study was undertaken over a four-year period at a university hospital in South Africa to review the disease spectrum and the clinical outcome of acute appendicitis. RESULTS A total of 1,004 patients (54% male, median age: 18 years) with intraoperatively confirmed appendicitis were reviewed. Over half (56%) were from the urban district within the city of Pietermaritzburg and the remaining 44% were from the rural health district. The median duration of illness from onset to definitive care was 4 days. Sixty per cent of appendices were perforated and associated with intra-abdominal contamination. Forty per cent of patients required reoperation to control intra-abdominal sepsis. Ten per cent required admission to the intensive care unit. The median overall length of hospital stay was 5 days. The mortality rate was 1%.Rural patients had a longer median duration of illness (3 vs 5 days, p<0.001) as well as a more advanced disease profile associated with perforation and severe intra-abdominal sepsis (19% vs 71%, p<0.001). Female patients had a longer median duration of illness (3 vs 4 days, p<0.001), were more likely to present with severe intra-abdominal sepsis (31% vs 54%, p<0.001) and were more likely to require a laparotomy (50% vs 73%, p<0.001). The total cost of managing the entire cohort of 1,004 patients over the 4-year period was £2,060,972. CONCLUSIONS Acute appendicitis in South Africa is a serious disease associated with significant morbidity. Late presentation is common. Female and rural patients have the worst clinical outcomes, with significant cost to the health system.

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confidence: 99%

Acute appendicitis in the developing world is a morbid disease

Kong

Sartorius

Clarke

2015

annals

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Acute Appendicitis—we thought we knew it all?

Cited by 1 publication

References 21 publications

Acute appendicitis in the developing world is a morbid disease

Acute appendicitis in the developing world is a morbid disease

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