Complicated appendicitis in Children in Aba, Nigeria

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Samuel Chidi Ekpemo, “Complicated appendicitis in Children in Aba, Nigeria”, ijmhs, vol. 9, no. 11, pp. 661–664, Nov. 2019.
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Abstract

Introduction: Acute appendicitis is one of the most common abdominal emergencies globally. Etiology
remains poorly understood with few advances over the past decades. Obtaining a confident pre-operative
diagnosis remains a challenge, as appendicitis must be entertained in any patient presenting with an acute
abdomen. A clinical classification is used to stratify management based on simple (non-perforated) and
complex (gangrenous or perforated) inflammation, although many patients remain with an equivocal
diagnosis, which remains one of the most challenging dilemmas. The aim of the study is to evaluate the
management and outcome of complicated appendicitis at the Abia State University Teaching Hospital
Aba Nigeria. Methodology: A prospective analysis of all children treated for appendicitis at the Abia
State University Teaching Hospital Aba between 2016 and December 2018. Proforma was opened for
demographic data, clinical presentation, diagnosis, treatment, complication and outcome. Results: A total
of 100 children aged between 2 and 15 (mean 8.7 ± 2.8) years, comprising 60males and 40 females with
male/female ratio 3:2 had appendectomy which accounted for 8% of total pediatric operations and 40% of
pediatric abdominal operations. Only 40 (40%) children presented during the first episode of symptoms
and in clinically stable state while 60 (60%) were referred after wrong diagnosis and treatment by general
practitioners which resulted in different complications ranging from appendix abscess 10 (10%), appendix
mass 15 (15%), perforated appendix 30 (30%), gangrenous appendix 5 (5%) . These influenced post
operative outcome with wound infection recorded in 20 (20%), wound break down 10 (10%), septicemia
15 (15%), pelvic abscess 5 (5%) and death 1 (1%). These were not recorded among those who presented
early who also had significantly lower duration of hospitalization and cost of treatment. Conclusion: Late
referral due to paucity of knowledge, long referral chain and low index of suspicion was rampant which
significantly increased associated morbidities and mortality among children managed with appendicitis
Keywords: Appendicitis, children, complicated

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References

1.Okafor PI, Orakwe JC, ChianakwanaGU. Management of appendiceal massesin a peripheral hospital in Nigeria: reviewof thirty cases. World J Surg2003;27:800-03. 2.Elmore JR, Dibbibs AW, Curci MR. Thetreatment of complicated appendicitis inChildren, what is the gold standard?.Arch Surg.1987;122:424-427. 3.Edino S. T, Mohammed A. Z, OchichaO. and Anumah M.. APPENDICITIS INKANO, NIGERIA: A 5-YEAR REVIEWOF PATTERN, MORBIDITY ANDMORTALITY/Annals of AfricanMedicine2004: Vol. 3, No. 1; 38 – 41 4.Iribhogbe P, Omorogiuwa I. AcuteAppendicitis In Young Children-ADiagnostic Challenge. JMBR 2006; 5(2):40-4 5.Osifo OD, Ogiemwonyi SO.Appendicitis in children: An increasinghealth scourge in a developing country.Pak J Med Sci April - June 2009 (Part-II)Vol. 25 No. 3 490-495. 6.Ibrahim Salih Elkheir, Sarah M Ahmed ,Fatima Saida Ahmed Yassin. Incidenceand prevalence of acute appendicitis atKhartoum North teaching hospitaI. Sch.J. App. Med. Sci., 2016; 4(6C):2045-2047/ 7.Adesunkanmi A. R. K, Agbakwuru E.A,Adekunle K.A. Pattern and outcome ofacute appendicitis in semi-urban andrural African communities: A study of125 patients. Nigerian Medical Practitioner 1998; 36: 8-11 8.Ogbonna B.C, Obekpa P.O, Momoh J.I,Ige J.T, Ihezue C.H. Another look atacute appendicitis in tropical Africa: thevalue of laparoscopy in diagnosis. TropDoct 1993; 23:82-8 9.Adekunle O.O, Funmilayo J.A. Acuteappendicitis in Nigeria. J R Coll SurgEdin 1986; 31: 102-105 10.Talabi OA, Sowande AO, OlowokereAS. Clinicopathological review of 156appendicectpmies for acute appendicitisin children in Ile Ife Nigeria. BMCEmergency medicine 2015 15:7. 11.Achibong AE, Ekanem I, Jibrin P.Appendicitis in South-eastern NigerianChildren. Cent Afr J Med 1995;41:94-7 12.Stamm D. Acute abdominal pain inchildren. Diagnostic orientation. RevPract 2000;50:1923-30. 13.Weinberger E, Winters WD. Abdominalpain and vomiting in infants and children:Imaging evaluation. Compr Ther1997;23:679-86 14.Taiwo O, Hayemi SO, Seriki O. Acuteappendicitis in Nigerian children. TropGeorgr Med 1977;29:35-40.

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References

1.Okafor PI, Orakwe JC, ChianakwanaGU. Management of appendiceal massesin a peripheral hospital in Nigeria: reviewof thirty cases. World J Surg2003;27:800-03.
2.Elmore JR, Dibbibs AW, Curci MR. Thetreatment of complicated appendicitis inChildren, what is the gold standard?.Arch Surg.1987;122:424-427.
3.Edino S. T, Mohammed A. Z, OchichaO. and Anumah M.. APPENDICITIS INKANO, NIGERIA: A 5-YEAR REVIEWOF PATTERN, MORBIDITY ANDMORTALITY/Annals of AfricanMedicine2004: Vol. 3, No. 1; 38 – 41
4.Iribhogbe P, Omorogiuwa I. AcuteAppendicitis In Young Children-ADiagnostic Challenge. JMBR 2006; 5(2):40-4
5.Osifo OD, Ogiemwonyi SO.Appendicitis in children: An increasinghealth scourge in a developing country.Pak J Med Sci April - June 2009 (Part-II)Vol. 25 No. 3 490-495.
6.Ibrahim Salih Elkheir, Sarah M Ahmed ,Fatima Saida Ahmed Yassin. Incidenceand prevalence of acute appendicitis atKhartoum North teaching hospitaI. Sch.J. App. Med. Sci., 2016; 4(6C):2045-2047/
7.Adesunkanmi A. R. K, Agbakwuru E.A,Adekunle K.A. Pattern and outcome ofacute appendicitis in semi-urban andrural African communities: A study of125 patients. Nigerian Medical Practitioner 1998; 36: 8-11
8.Ogbonna B.C, Obekpa P.O, Momoh J.I,Ige J.T, Ihezue C.H. Another look atacute appendicitis in tropical Africa: thevalue of laparoscopy in diagnosis. TropDoct 1993; 23:82-8
9.Adekunle O.O, Funmilayo J.A. Acuteappendicitis in Nigeria. J R Coll SurgEdin 1986; 31: 102-105
10.Talabi OA, Sowande AO, OlowokereAS. Clinicopathological review of 156appendicectpmies for acute appendicitisin children in Ile Ife Nigeria. BMCEmergency medicine 2015 15:7.
11.Achibong AE, Ekanem I, Jibrin P.Appendicitis in South-eastern NigerianChildren. Cent Afr J Med 1995;41:94-7
12.Stamm D. Acute abdominal pain inchildren. Diagnostic orientation. RevPract 2000;50:1923-30.
13.Weinberger E, Winters WD. Abdominalpain and vomiting in infants and children:Imaging evaluation. Compr Ther1997;23:679-86
14.Taiwo O, Hayemi SO, Seriki O. Acuteappendicitis in Nigerian children. TropGeorgr Med 1977;29:35-40.

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