An audit of appendicitis and appendicectomy in Kumasi, Ghana

Background: Acute appendicitis is a leading cause of emergency admission into our hospital. A report on 638 surgical abdominal explorations following emergency admissions for suspected acute appendicitis is presented. The study was conducted at the Komfo Anokye Teaching Hospital between January 1998 and December 2004. Method: During the 7-year period, all consecutive adult patients admitted to our hospital emergency department with suspected appendicitis and who subsequently had an operation done provided the material for the study. Patients whose symptoms settled without operation were excluded. A special proforma was designed to record patient demographic details, clinical features, laboratory data, operative findings and outcome of treatment. Results: Six hundred and thirty-eight patients were studied. These were 408 men and 230 women; a male to female ratio of 1.7:1. The mean age was 32.4 ± 15.0 S.D years. All patients were admitted with abdominal pains that were initially located at the umbilicus in 38.0% and diffused in 31.8%. Vomiting 85.7%, fever 73.0% and anorexia 49.0% were the most frequent associated symptoms. The mean duration of illness was 74 hours. Right iliac fossa pain and tenderness were present in 612 patients (89.22%). The total white cell count was significantly raised (p = 0.05). Six hundred and thirty-eight appendicectomies were performed. Th irty-nine percent (249/638) of the appendices were perforated at operation and 25.9% (56/216) of the removed appendices had no histological evidence of inflammation. The complication rate was 43.1% and wound infection (41.5%) was the most common. The average stay in hospital was 7 days. There were 12 deaths - a mortality rate of 1.9% - mostly elderly patients. Conclusion: The diagnosis of appendicitis in our environment is clinical and based mainly on the combination of abdominal pains, signs of peritoneal irritation, and a raised total white cell count with neutrophilia. This mode of presentation is similar to that seen in other communities. The treatment of appendicitis in our hospital is appendicectomy. The negative appendicectomy rate of 25.9% falls within the range reported in other studies. More than a third of the appendices were perforated. The considerable morbidity and appreciable mortality from acute appendicitis in our community are due mainly to the late presentation of our patients.