Appendiceal Diseases in Children in a University Teaching Hospital in Southwest Nigeria

Authors

  • Chigbundu Collins Nwokoro Olabisi Onabanjo University Teaching Hospital, Sagamu, Ogun State
  • LO Amosu
  • IO Ogundele
  • AR Oso
  • IA Babajimi-Joseph
  • EA Kalesanwo

DOI:

https://doi.org/10.30442/ahr.1002-08-236

Abstract

Background: Appendicitis is common, with a lifetime occurrence of 7 per cent. It is an urgent surgical illness with a wide range of manifestations and extensive overlap with other clinical syndromes.

Objective: To examine the presentation, differential diagnoses and complications of appendiceal diseases.

Methods: An eight-year retrospective study (18 July 2016 - 18 August 2023) was carried out in a Nigerian Teaching Hospital. All cases of appendiceal diseases managed in children during the study were included. Case notes of patients who were managed from admission through surgical intervention, discharge from the hospital, and complete follow-up at the paediatric outpatient clinic were selected for data retrieval and further processing.

Results: Four hundred children with appendiceal diseases were seen during the study period. However, only 250 patients’ case records were studied. Out of the 250 children studied, 170 were males (68%), giving a male-to-female ratio of 2.1:1. The age range was one year to 15 years. Those aged 7-12 years were in the majority (175; 70%). Most of the children (80; 32%) presented late to the hospital with the presence of complications, which occurred more in those aged less than 7 years (150; 75%). The complications included a ruptured appendix with generalised peritonitis (40; 50%), localised peritonitis (18; 22.5%), appendiceal mass (16; 20%), and gangrene of the appendix (6; 7.5%).

Conclusion: Acute appendicitis is one of the causes of acute abdominal conditions in children. Delayed presentation is common. Complications at presentation were associated with young age and late presentation.

References

Ohene-Yoboah M, Togbe B. An audit of appendicitis and appendicectomy in Kumasi, Ghana. West Afr J Med 2006;25:138-143.

Pierluigi M, Claudio G, Baruch SK and Egido B. Appendicitis in children less than five years old: A challenge for the general practitioner. World J Clin Pediatr 2015;4:19-24. https://doi.org/10.5409/wjcp.v4.i2.19

Francesco M, Thomas VS. Acute appendicitis in early childhood. J Pediatr 1958;52:324-328. https://doi.org/10.1016/S0022-3476(58)80124-9

Andersen S, Paerregaard A, Larsen K. Changes in the epidemiology of acute appendicitis and appendectomy in Danish children 1996-2004. Eur J Ped Surg 2009;19:286-289. https://doi.org/10.1055/s-0029-1224199

Meier DE, Guzzetta PC, Barber RG, Hynan LS, Seetheramaiah R. Perforated appendicitis in children: is there a best treatment? J Pediatr Surg. 2003;38:1520-1524. https://doi.org/10.1016/s0022-3468(03)00549-9

Lund DP, Murphy EU. Management of perforated appendicitis in children: a decade of aggressive treatment. Pediatr Surg 1994;29:1130-1133. https://doi.org/10.1016/0022-3468(94)90294-1

Bouree P and Dubourdieu M. Parasitic appendicitis. Apropos of 4 cases of acute appendicitis. Bull Soc Pathol Exot Filiales 1984;77:81-89. https://pubmed.ncbi.nlm.nih.gov/6722963/

Dahlstrom JE, Macarthur EB. Enterobius vermicularis: a possible cause of symptoms resembling appendicitis. Aust N Z J Surg., 1994;64:692-694. https://doi.org/10.1111/j.1445-2197.1994.tb02059.x

Gupta SC, Gupta AK, Keswani NK, Siggh PA, Tripathi AK, Krishna V. Pathology of tropical appendicitis. J Clin Pathol. 1989;1169-1172. https://doi.org/10.1136/jcp.42.11.1169

Shapiro R, Eldar S, Sadot E, Papa MZ, Zippel DB. Appendiceal carcinoid at a large tertiary centre: pathologic findings and long-term follow-up evaluation. Am J Surg 2011;201:805-808. https://doi.org/10.1016/j.amjsurg.2010.04.016

AbdullGaffar B. Granulomatous diseases and granulomas of the appendix. Int J Surg Pathol 2010;18:14-20. https://doi.org/10.1177/1066896909349246

Addiss DG, Shaffer N, Fowler BS. The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol 1990;132:910-925. https://doi.org/10.1093/oxfordjournals.aje.a115734

Adejuyigbe O, Fadiran OA. Pattern of acute appendicitis on Nigerian children. Ann Trop Paediatr 1989;9:93-97. https://doi.org/10.1080/02724936.1989.11748605

Satti MB, Tamimi DM, Al Sohaibani MO, Al Quorain A. (1987): Appendicular schistosomiasis: a cause of clinical acute appendicitis?. J Clin Pathol 1987; 40: 424-428. https://doi.org/10.1136/jcp.40.4.424

Hale DA, Molloy M, Pearl RH, Schutt DC, Jaques DP. Appendectomy: a contemporary appraisal. Ann Surg 1997;225:252-261. https://doi.org/10.1097/00000658-199703000-00003

Ortega AE, Hunter JG, Peters JH, Swanstorm LL, Schirmer B. A prospective randomised comparison of laparoscopic appendectomy with open appendectomy. Am J Surg 1995;169:208-213. https://doi.org/10.1016/s0002-9610(99)80138-x

Styrud J, Eriksson S, Segelman J, Granstrom L. Diagnostic accuracy in 2.351 patients undergoing appendicectomy for suspected acute appendicitis: A retrospective study 1986-1993. Dig Surg 1999; 16: 39-44. https://doi.org/10.1159/000018692

Akbulut S, Tas M, Sogutcu N, Arikanoglu Z, Basbug M, Ulku A, et al. Unusual histopathological findings in appendectomy specimens: a retrospective analysis and literature review. World J Gastroenterol 2011;17:1961-1970. https://doi.org/10.3748/wjg.v17.i15.1961

Ayoade BA, Olawoye OA, Salami BA, Banjo AAF. Acute appendicitis in Olabisi Onabanjo University Teaching Hospital, Sagamu, a three-year review. Niger J Clin Pract 2006;9:52-56. https://pubmed.ncbi.nlm.nih.gov/16986291

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. https://www.ajol.info/index.php/aam/article/view/8300

Ademola TO, Oludayo SA, Samuel OA, Amarachukwu EC, Akinwunmi KO, Olusanya A. Clinicopathological review of 156 appendicectomies for acute appendicitis in children in Ile-Ife, Nigeria: a retrospective analysis. BMC Emerg Med 2015;15:7. https://doi.org10.1186/s12873-015-0030-9

Okafor PI, Orakwe JC, Chianakwana GU. Management of appendiceal masses in a peripheral hospital in Nigeria: review of thirty cases. World J Surg 2003;27:800-803. https://doi.org/10.1007/s00268-003-6891-1

Afenigus AD, Bayieh AM, Kassahun B. Treatment outcomes of acute appendicitis and associated factors among admitted patients with a diagnosis of acute abdomen in Debre Markos Referral Hospital, Amhara Region, North West Ethiopia. J Per-operative Pract. 2022;32:123-130. https://doi.org/10.1177/1750458920928473

Mariage M, Sabbagh C, Grelpois G, Prevot F, Darmon I, Regimbeau JM. Surgeon’s Definition of Complicated Appendicitis: A Prospective Video Survey Study. Euroasian J Hepato-gastroenterol 2019;9:1-4. https://doi.org/10.5005/jp-journals-10018-1286

Terasawa T, Blackmore CC, Bent S, Kohlwes RJ. Systematic review: computed tomography and ultrasonography to detect acute appendicitis in adults and adolescents. Ann Intern Med 2004;141:537-546. https://doi.org/10.7326/0003-4819-141-7-200410050-00011

Gauderer MW. An individualised approach to appendectomy in children based on anatomic-laparoscopic findings. Am Surg. 2007;73:814-817. https://doi.org/10.1177/000313480707300

Anisha S, Joselito T, Chris K, Yves H, Peter F, Wei C. Stepwise Approach to Laparoscopic Appendicectomy in Children. Indian J Surg 2014;76:243-246. https://doi.org/10.1007/s12262-013-0858-8

Singg M, Kadian YS, Rattan KN, Jangra B. Complicated appendicitis: analysis of risk factors in Children. Afr J Paediatr Surg 2014;11:109-113. https://doi.org/10.4103/0189-6725.132796

Barlow A, Muhleman M, Gielecki J, Matusz P, Tubbs RS, Loukas M. The vermiform appendix: a review. Clin Anat 2013;26:833-842. https://doi.org/10.1002/ca.22269

Anna MC, Alessandro P, Roberto G, Pietro A, Marcello P, Alessandra C, Luigi M. Acute appendicitis in children: not only surgical treatment. J Ped Surg 2016;52:444-448. https://doi.org/10.1016/j.pedsurg.2016.08.007

Erdogan D, Karaman I, Narci A, Karaman A, Cavusoglu YH, Aslan MK, et al. Comparison of two methods for the management of appendicular mass in children. Pediatr Surg Int. 2005;21:81-83. https://doi.org/10.1007/s00383-004-1334-0

Hao Wu, Murali C, John H, Jed GN, Fatih MO, Rajkumar V. Neuroendocrine Tumor of the Appendix in Children. J Pediatr Hematol Oncol. 2017;39:97-102. https://doi.org/10.1097/MPH.0000000000000598

Emmanuouil H, Paraskevi P, Vasiliki SF, Loanna F, Dimitrios EK. Carcinoid tumours of the appendix in children: experience from a tertiary centre in northern Greece. J Pediatr Gastroenterol Nutr 2010;51:622-625. https://doi.org/10.1097/MPG.0b013e3181e05358

Agarwal P, Sharma D, Agarwal A, Agarwal V, Tandon A, Baghel KD, et al. Tuberculosis Appendicitis in India. Trop Doctor. 2004;34:36-38. https://doi.org/10.1177/004947550403400118

Ardalan MR, Shoja MM and Ghabili K. Concomitant pulmonary tuberculosis and tuberculous appendicitis in a recipient of a renal transplant: a case report. J Med Case Reports 2011;5:191. https://doi.org/10.1186/1752-1947-5-191

Eren A, Veli A and Meltem A. Parasitic infestation in appendicitis. A retrospective analysis of 660 patients and brief literature review. Saudi Med J 2017;38:314-318. https://doi.org/10.15537/smj.2017.3.18061

Withers A, Loveland J. Demographics of paediatric patients presenting with acute appendicitis: A 5-year retrospective review of hospitals served by the Department of Paediatric Surgery at the University of the Witwatersrand. S Afr J Child Health. 2019;13:69-72. https://doi.org/10.7196/sajch.2019.v13i2.1557

Kong VY, Sartorius B, Clarke DL. Acute appendicitis in the developing world is a morbid disease. Ann R Coll Surg Engl 2015;97:390-395. https://doi.org/10.1308/003588415X14181254790608390

Brittney MW, Laura NP, Carlos V, Jared G, Anthony C. Appendicitis Mortality in a Resource-Limited Setting: Issues of Access and Failure to Rescue. J Surg Res 2021;259:320-325. https://doi.org/10.1016/j.jss.2020.09.030

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Published

2024-06-30

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Original Research