CLINICAL AND PATHOLOGICAL PRESENTATION OF ACUTE APPENDICITIS AT CHUK: RETROSPECTIVE STUDY FROM 2019-2020

Author(s):
Bonaventure MUHOZA; Miguel Gasakure

Background:

Appendicitis is the inflammation of the finger-shaped pouch originating from the cecum called appendix. This
study has been done at CHUK, with the objectives of analyzing the clinical presentation and laboratory findings
of patients with acute appendicitis and their final management.

Hypothesis:

Our research is a clinical pathological study that provided an overview of
acute appendicitis and its management in CHUK, one of the biggest teaching
hospitals in Rwanda, by analyzing the clinical presentation as well as laboratory
and radiological findings of patients with acute appendicitis and their final
management at CHUK.

Methods:

This study was a cross-sectional descriptive retrospective study using data from patient’s files stored at
CHUK’s archive. We selected all patients, above 16years old who, during the period 1st January 2019 to 31st
December 2020, have consulted surgery Department at CHUK, and have been diagnosed of having acute
appendicitis. We excluded patient with septic shock and immunosuppression. We performed a descriptive
analysis using the following variables: gender, patient’s residency, reason of transfer, clinical presentation,
complications at arrival, Alvarado score, investigations & biopsy results, management, surgery performed and
post-operative complications.

Results:

We identified 121 patients who met inclusion criteria; 43% patients in 2019 and 57% patients in 2020. 61%
were male and 39% female. 45% patients were from Kigali and among them 98% were Rwandan and only 2%
were foreign patients. The average age distributed by Gender was 38 years (female) and 32 years (male). Most
of patients presented complaining of migratory right abdominal pain (83%) and on Physical exam 93% were
having tenderness in right lower quadrant. The average of days with symptoms before admission were 8 days.
On laboratory investigations 59 % (n=71) were having Leukocytosis, among them 18 % (n=13) had left shift. It
is important to note that 45% presented with ruptured appendix. 95% were treated surgically and 23% of them
had post-operative complications. , 46% were surgical site infection. Appendicular biopsy taken post
appendectomy showed 96% to be inflammatory cause while 4% malignancy.

Conclusions:

71% of appendicitis arrive at the CHUK late with
complicated appendicits resulting in high morbidity and
mortality (23%)

Malignancy should never be dismissed and it would be
important that specimens are properly followed up

Awareness of acute appendicitis at HC/DH may decrease
delay in diagnosis and definitive management.

Further multi center studies are required to properly
describe the Rwandan epidemiology with regards to Acute
appendicitis