Complicated appendicitis in Children in Aba, Nigeria

Abstract

Introduction: Acute appendicitis is one of the most common abdominal emergencies globally. Etiologyremains poorly understood with few advances over the past decades. Obtaining a confident pre-operativediagnosis remains a challenge, as appendicitis must be entertained in any patient presenting with an acuteabdomen. A clinical classification is used to stratify management based on simple (non-perforated) andcomplex (gangrenous or perforated) inflammation, although many patients remain with an equivocaldiagnosis, which remains one of the most challenging dilemmas. The aim of the study is to evaluate themanagement and outcome of complicated appendicitis at the Abia State University Teaching HospitalAba Nigeria. Methodology: A prospective analysis of all children treated for appendicitis at the AbiaState University Teaching Hospital Aba between 2016 and December 2018. Proforma was opened fordemographic data, clinical presentation, diagnosis, treatment, complication and outcome. Results: A totalof 100 children aged between 2 and 15 (mean 8.7 ± 2.8) years, comprising 60males and 40 females withmale/female ratio 3:2 had appendectomy which accounted for 8% of total pediatric operations and 40% ofpediatric abdominal operations. Only 40 (40%) children presented during the first episode of symptomsand in clinically stable state while 60 (60%) were referred after wrong diagnosis and treatment by generalpractitioners which resulted in different complications ranging from appendix abscess 10 (10%), appendixmass 15 (15%), perforated appendix 30 (30%), gangrenous appendix 5 (5%) . These influenced postoperative outcome with wound infection recorded in 20 (20%), wound break down 10 (10%), septicemia15 (15%), pelvic abscess 5 (5%) and death 1 (1%). These were not recorded among those who presentedearly who also had significantly lower duration of hospitalization and cost of treatment. Conclusion: Latereferral due to paucity of knowledge, long referral chain and low index of suspicion was rampant whichsignificantly increased associated morbidities and mortality among children managed with appendicitisKeywords: Appendicitis, children, complicated

COVID-19 and Complicated Appendicitis: What is the Relationship?

“…This approach of referring emergency cases to centres that are better prepared and equipped to manage potential COVID-19 cases presenting with acute abdomen could potentially cause a delay in operative intervention, which is another possible reason for the apparent increase in cases of complicated appendicitis. In Nigeria, most cases of acute appendicitis are addressed at the secondary healthcare levels or private hospitals [20]. Due to lack of resources to diagnose and manage potential cases of COVID-19 as commonly observed in Nigeria, [21] these centres may now be reluctant to accept emergencies including those presenting with acute appendicitis.…”

Healing Factors in Perforated and Unperforated Pediatric Appendectomies: A Descriptive Study

“…15 Upon reviewing the literature, we observed that the most common symptom of appendicitis was abdominal pain, corroborating our study's findings, followed by nausea, vomiting, fever, and loss of appetite. 3,4,17 This underscores that gastrointestinal symptoms in children, extending beyond abdominal pain and nausea, may also indicate conditions like appendicitis.…”

“…The organ becomes susceptible to pathogens, and the presentation of appendicitis emerges. [1][2][3][4] The general appendectomy rate in children is reported to be 8.4%. Appendicitis can occur at any age.…”

“…However, it is most common between the ages of 10 and 19 years. [3][4][5] In girls and children under the age of six, the rate has been reported to be higher. 1,6 At diagnosis, the most common treatment is surgery, which remains the mainstay of treatment in most hospitals.…”

“…1,6 At diagnosis, the most common treatment is surgery, which remains the mainstay of treatment in most hospitals. 3,[5][6][7][8] Whether the surgery is laparoscopic or open depends on the child's examination findings. 4 A multidisciplinary team approach involving doctors and nurses is essential for treating appendicitis.…”