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

Talabi O Ademola, Sowande A Oludayo, Olowookere A Samuel, Etonyeaku C Amarachukwu, Komolafe O Akinwunmi, Adejuyigbe Olusanya, Talabi O Ademola, Sowande A Oludayo, Olowookere A Samuel, Etonyeaku C Amarachukwu, Komolafe O Akinwunmi, Adejuyigbe Olusanya

Abstract

Background: Acute 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.

Methods: This 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.

Results: There were 80 (57.6%) females and 59 (42.4%) males. The age range was 5-15 years 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.

Conclusion: Late presentation was common and was associated with longer duration of hospital stay and high morbidity. No mortality was recorded from the disease.

References

    1. Aiken JJ, Oldham KT. Acute appendicitis. In: Kliegman RM, Stanton BF, St. Geme JW, Schor NF, Behrman RE, editors. Nelson Textbook of Pediatrics. 19. Philadelphia, PA: Saunders; 2011. pp. 1349–55.
    1. John J, Hanini S, Popoiu CM. Acute appendicitis in infants and toddlers: rare but challenging. J Pediatr. 2009;12:45–6.
    1. Arif AS, Amin S, Quamruzzaman SM, Anisur RM. Diagnosing acute. appendicitis in children using Alvarado score. AKMMC J. 2011;2:11–3.
    1. Edino ST, Mohammed AZ, Ochicha O, Anumah M. Appendicitis in Kano, Nigeria: A 5 year review of pattern, morbidity and mortality. Ann Afr Med. 2004;3:38–41.
    1. Adejuyigbe O, Fadiran OA. Pattern of appendicitis in Nigerian children. Ann Trop Paediatr. 1989;9:93–7.
    1. Lamps LW. Infectious causes of appendicitis. Infect Dis Clin North Am. 2010;24:995–1018. doi: 10.1016/j.idc.2010.07.012.
    1. Abes M, Perik B, Kazil S. Nonoperative treatment of acute appendicitis in children. J Pediatr Surg. 2007;42:1439–42. doi: 10.1016/j.jpedsurg.2007.03.049.
    1. Wilcox RT, Traverso LW. Have the evaluation and treatment of acute appendicitis changed with new technology? Surg Clin North Am. 1997;77:1355–70. doi: 10.1016/S0039-6109(05)70622-8.
    1. Williams N, Bello M. Perforation rate relates to delayed presentation in childhood acute appendicitis. J R Coll Surg Edinb. 1998;43:101–2.
    1. Abantanga FA. Acute appendicitis in children in Kumasi, Ghana: Macroscopic findings at laparotomy. Afr J Paediatr Surg. 2004;1:6–10.
    1. Taiwo O, Itayemi SO, Seriki O. Acute appendicitis in Nigerian children. Trop Geogr Med. 1977;29:35–40.
    1. Uba AF, Lohfa LB, Ayuba MD. Childhood acute appendicitis. Is routine appedicectomy advised? J Indian Assoc Pediatr Surg. 2006;11:27–30. doi: 10.4103/0971-9261.24634.
    1. von Suchodoletz H, Volzer H. Distinctive features of appendicitis in childhood. Zentraibl Chir. 2008;133:554–8. doi: 10.1055/s-2008-1076877.
    1. Chamisa IA. Clinicopathological review of 324 appendices removed for acute appendicitis in Durban, South Africa: A retrospective analysis. Ann R Coll Surg Engl. 2009;91:688–92. doi: 10.1308/003588409X12486167521677.
    1. Naaeder SB. The Appendix. In: Badoe EA, Archampong RQ, Da Rocha-Afodu JT, editors. Principles and practice of surgery including pathology in the tropics. 4. Accra: Ghana Publishing Corporation; 2009. pp. 561–71.
    1. O’ Connell PR. The vermiform appendix. In: Russell RCG, Williams NS, Bulsterode CJK, editors. Bailey and Love’s short practice of surgery. 25. London: Arnold; 2008. pp. 1204–18.
    1. Bergeron E. Clinical judgment remains of great value in the diagnosis of acute appendicitis. J Can Chiropr. 2006;49:96–100.
    1. Alvarado A. A practical score for the early diagnosis of acute appendicitis. Ann Emerg Med. 1986;15:557–64. doi: 10.1016/S0196-0644(86)80993-3.
    1. McKay R, Shepherd J. The use of the clinical scoring system by Alvarado in the decision to perform computed tomography for acute appendicitis in the ED. Am J Emerg Med. 2007;25:489–93. doi: 10.1016/j.ajem.2006.08.020.
    1. Kwan KY, Nager AL. Diagnosing pediatric appendicitis: usefulness of laboratory markers. Am J Emerg Med. 2010;28(9):1009–15. doi: 10.1016/j.ajem.2009.06.004.
    1. Beltrán MA, Almonacid J, Vicencio A, Gutiérrez J, Cruces KS, Cumsille MA. Predictive value of white blood cell count and C-reactive protein in children with appendicitis. J Pediatr Surg. 2007;42(7):1208–14. doi: 10.1016/j.jpedsurg.2007.02.010.
    1. Wu H-P, Lin C-Y, Chang C-F, Chang Y-J, Huang C-Y. Predictive value of C-reactive protein at different cutoff levels in acute appendicitis. Am J Emerg Med. 2005;23(4):449–53. doi: 10.1016/j.ajem.2004.10.013.
    1. Kim E, Subhas G, Mittal, Golladay ES. C-reactive protein estimation does not improve accuracy in the diagnosis of acute appendicitis in pediatric patients. Int J Surg. 2009;7(1):74–7. doi: 10.1016/j.ijsu.2008.11.001.
    1. Colson M, Skinner KA, Dunnington G. High negative appendicectomy rates are no longer acceptable. Am J Surg. 1997;174:723–6. doi: 10.1016/S0002-9610(97)00183-9.
    1. Moir CR. Appendectomy: open and laparoscopic approaches. In: Spitz L, Coran Arnold G, editors. Operative Pediatric Surgery. 6. London: Edward Arnold Publishers Ltd; 2006. pp. 455–65.
    1. Ricci MA, Trevisani M, Beck WC. Acute appendicitis – a 5-year review. Am Surg. 1991;57:301–5.
    1. Mason JH, Byrne MP, Gaw FC. Surgery of the vermiform appendix. Surg Clin North Am. 1977;57:1303–15.
    1. Duvie SOA, Diffange MN, Gurgui S. The effects of Schistosoma haematobium on the vermiform appendix: the Nigerian experience. J Trop Med Hyg. 1987;98:13–8.

Source: PubMed

スポンサーと協力者

医学的状態

薬物療法

3
購読する