Acute appendicitis in childhood: experience in a developing country

Abstract

Appendicitis is a common cause of acute abdominal pain in childhood. Four hundred and thirty-six children 15 years of age and younger with histologically proven acute appendicitis were treated surgically over an 11-year period (1983–1993). Epidemiological differences suggested a lower prevalence in the black African and mixed ethnic groups in comparison to Caucasian children. There was no evidence suggesting that appendicitis was an emerging disease in the period under study. Appendicitis occurred at any age, but only 24% of cases presented in the first 8 years of life, the peak incidence being from 11 years onwards. There were 3 neonates in this series who presented in a similar fashion to necrotising enterocolitis. One of these was shown to have Hirschsprung's disease at post-mortem examination. There were no striking differences in the clinical presentation between groups, but a higher incidence of complicated appendicitis was identified in the younger age group and those from poor socioeconomic situations. The male:female ratio was 1.74 overall. A male preponderance was also identified in patients presenting pre- and post-puberty. Seasonal variation was present, with the highest incidence being in the summer months. Intestinal helminths coexisted in 9.4% of cases; the majority were ova of Ascaris lumbricoides. A low incidence of faecoliths was recognised. Clinicopathological correlation showed an incidence of 41% (177 patients) with acute appendicitis, 47% (203) with perforated appendicitis, 4% (20) with a walled-off appendix abscess, and 7% (32) with gangrenous appendicitis. The remaining 1% showed chronic inflammatory changes. A mortality of 0.4% (2 patients) resulted from complications attributable to late diagnosis, generalised peritonitis, and septicaemia.