Clinicopathological review of 156 appendicectomies for acute appendicitis in children in Ile-Ife, Nigeria: a retrospective analysis

Abstract

BackgroundAcute appendicitis is one of the most common causes of acute abdomen in children. Late surgical intervention is often associated with increase morbidity and sometimes fatal outcome. We sought to determine the pattern of presentation of acute appendicitis, and the effect of late presentation on surgical outcome in children.MethodsThis is a retrospective descriptive study done at the paediatric surgical unit of Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria. The hospital records of all 180 patients (15 years and below) treated for acute appendicitis, between January 1995 and December 2012, were reviewed; only 156 patients had adequate records out of which 139 cases confirmed histologically as having appendicitis were analyzed.ResultsThere were 80 (57.6%) females and 59 (42.4%) males. The age range was 5-15years with mean (SD) age of 11.2 (±2.9) years. Most patients (64.7%) were more than 10 years old. Sixty-four (46%) patients had simple appendicitis while 75 (54%) patients had complicated appendicitis. More children with complicated appendicitis (63, 84.0%) presented after 24 hours of abdominal pain; and they had more vomiting (59, 78.7%), spent longer days on admission (57, 76.0%) and had more post- operative complications (34, 45.3%) compared with uncomplicated appendicitis (25, 39.1%; 29, 45.3%; 7, 10.9%; 1, 1.6% respectively), and this was statistically significant (p < 0.05). No mortality was recorded among these children.ConclusionLate presentation was common and was associated with longer duration of hospital stay and high morbidity. No mortality was recorded from the disease.

Surgical Abdomen in School Age Children: A Prospective Review From Two Centers In SouthWestern Nigeria

“…Our findings showed that when the aetiology of surgical abdomen was matched with age groups and gender of our patients, the relative frequency of the various causes was consistent with earlier reports was obtained [1][2][3][7][8][9][10][11] . Patients below five years were excluded from the study as most of them were referred directly to the specialist paediatrics surgery unit where better ancillary support [intensive care unit and paediatrics anaesthetists] services were available.…”

“…Thus surgical site infection occurring as the most common post-operative complication was not surprising in patients with intra-abdominal sepsis when compared with other causes of surgical abdomen in this study. The high rate of surgical site infection amongst patients with complicated intra-abdominal sepsis, like typhoid ileal perforation, corroborates earlier reports 8,10,11,13,15 . Furthermore patients with typhoid ileal perforation constituted the bulk of patients with post-operative complications; this may be due to the pan-systemic nature of the disease with septicaemia.…”

“…Similar late presentation by patients had been noted by researchers across diverse specialties for different disease states [8][9][10][11][12][13][14][15] . This delay had been attributed to poverty 16 and the poor health seeking behaviour of the populace 9 which may manifest as self-medication, patronage of unorthodox medical practitioners and quacks before coming to the hospital.…”

“…There may not be unconnected with sub-acute peritoneal inflammations causing adhesive intestinal obstruction 24 . This is especially true in females who are prone to pelvic inflammatory conditions; and also in individuals in the second decade of life who have higher prevalence of appendicitis 11 . However there is need for further studies involving a larger population to affirm this assertion.…”

“…This could alter the temporal profile and mask clinical features of diseases; thus promoting delayed presentation and diagnosis with attendant propensity towards disease complication at presentation. Moreover, patients with surgical abdomen who present late do so in poor physiologic states: with fluid, electrolyte and acid-base imbalance [8][9][10][11][12][13][14] . Similarly, patients with surgical abdomen from trauma could have haemoperitoneum sufficient enough to cause hypovolaemic shock requiring correction.…”