CLINICAL AND PATHOLOGICAL PRESENTATION OF ACUTE APPENDICITIS AT CHUK: RETROSPECTIVE STUDY FROM 2019-2020
Author(s):
Miguel Gasakure; Bonaventure MUHOZA; Aime NIYIBIGENGA
Background:
Appendicitis is the inflammation of the finger-shaped pouch originating from the cecum called appendix.
Acute appendicitis is the commonest condition of the appendix which is most of the time secondary to the obstruction of the appendicular lumen which lead to the distension of the appendix; this causes overgrowth of bacteria resulting in the inflammation of the appendix.
Our research provides an overview of acute appendicitis and its epidemiology in CHUK, one of the biggest teaching hospitals in Rwanda, by analyzing the clinical presentation and laboratory findings of patients with acute appendicitis and their final management at CHUK.
Hypothesis:
There is no significant association between socio-demographic factors, clinical presentation, and short term complications in patients diagnosed with acute appendicitis in CHUK.
Methods:
Cross-sectional descriptive retrospective study, on all patients presented at University Teaching Hospital (CHUK) surgery department between January 2019 and December 2020, who presented with signs & symptoms of acute appendicitis and whom the acute appendicitis has been confirmed using lab and imaging investigations.
Data was collected retrospectively from patient’s files stored in CHUK’s Archives. The Data was collected using a pre-established questionnaire.
Data was recorded using Microsoft Excel and Data analysis was carried out using STATA.
Inclusion criteria:
All patients 16 years and above, from 1st January 2019 to 31st December 2020 and consulting the General surgery Department at CHUK with a diagnosis of acute appendicitis.
Exclusion criteria:
We excluded all patients in septic shock and who were immunosuppressed
Results:
121 patients were enrolled. 61% were male and 39% female. 45% patients were from Kigali. The average age distributed by gender was 38 years (female) and 32 years (male). Most patients complained of migratory right abdominal pain (83%) and on Physical exam 93% had RLQ tenderness. The average days with symptoms before admission was 8 days.
On laboratory investigations 59 % (n=71) had Leukocytosis, among them 18 % (n=13) with a 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 mostly surgical site infection (46%). Appendicular biopsy taken post
appendectomy showed 96% to be inflammatory cause while 4% were malignant.
Conclusions:
71% of patients arrive at CHUK late with complicated acute appendicitis resulting in peritonitis and increased morbidity. Awareness of typical presentation of acute appendicitis at the community level could decrease delays in diagnosis, transfer and definitive management of acute appendicitis.