Appendicitis in Low-Resource Settings

Abstract

Background: Acute appendicitis is one of the most common surgical emergencies globally. Its incidence is increasing in low-and middle-Human Development Index countries (LMHDICs). Although a proportion of patients can be treated successfully with non-operative management consisting of antibiotics, supportive therapy, and close observation, current diagnostic algorithms lack the granularity to identify these patients accurately. Methods: We reviewed published literature describing practice patterns and clinical outcomes for appendicitis in LMHDICs and compared them with studies from high-Human Development Index countries, as well as guidelines published by international surgical societies. Results: We identified shortcomings in current diagnostic and therapeutic strategies used in LMHDICs. Delays in obtaining surgical care inherent in many LMHDIC healthcare systems make prompt surgical care the mainstay for the treatment of acute appendicitis. Laparoscopic appendectomy leads to better outcomes than open appendectomy in resource-constrained settings and when available should be the surgical technique of choice. Conclusions: Acute appendicitis is common in LMHDICs, and if possible, laparoscopic appendectomy should be the procedure of choice.

Management of intra-abdominal-infections: 2017 World Society of Emergency Surgery guidelines summary focused on remote areas and low-income nations

“…The Modified Alvarado Scoring System (MASS) had a sensitivity of 94.1% and a specificity of 90.4% in Tanzanian patients with suspected acute appendicitis (Kanumba et al, 2011). These discrepancies can be explained by the different weights of the variables in the clinical scores, as reported by Bessoff and Forrester (2020). Several clinical scores such as the AIR (Appendicitis Inflammatory Response) score and the AAS (Adult Appendicitis Score) score cannot be performed in limited resource settings due to the requirement for expensive tests such as C-reactive protein (CRP).…”

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“…The resulting frustration contributes to patients’ decision to carry on despite painful surgical conditions or wait to seek care until their conditions become emergent. These ongoing delays in the referral process can negatively impact outcomes [ 24 , 25 ].…”