Acute appendicitis in the developing world is a morbid disease.
BACKGROUND
Acute appendicitis in the developing world has a markedly different disease profile to that in the developed world.


METHODS
A retrospective study was undertaken over a four-year period at a university hospital in South Africa to review the disease spectrum and the clinical outcome of acute appendicitis.


RESULTS
A total of 1,004 patients (54% male, median age: 18 years) with intraoperatively confirmed appendicitis were reviewed. Over half (56%) were from the urban district within the city of Pietermaritzburg and the remaining 44% were from the rural health district. The median duration of illness from onset to definitive care was 4 days. Sixty per cent of appendices were perforated and associated with intra-abdominal contamination. Forty per cent of patients required reoperation to control intra-abdominal sepsis. Ten per cent required admission to the intensive care unit. The median overall length of hospital stay was 5 days. The mortality rate was 1%. Rural patients had a longer median duration of illness (3 vs 5 days, p<0.001) as well as a more advanced disease profile associated with perforation and severe intra-abdominal sepsis (19% vs 71%, p<0.001). Female patients had a longer median duration of illness (3 vs 4 days, p<0.001), were more likely to present with severe intra-abdominal sepsis (31% vs 54%, p<0.001) and were more likely to require a laparotomy (50% vs 73%, p<0.001). The total cost of managing the entire cohort of 1,004 patients over the 4-year period was £2,060,972.


CONCLUSIONS
Acute appendicitis in South Africa is a serious disease associated with significant morbidity. Late presentation is common. Female and rural patients have the worst clinical outcomes, with significant cost to the health system.
Pietermaritzburg Metropolitan Hospital Complex, Nelson R Mandela School of Medicine, University of KwaZulu-Natal , South Africa.
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VY
Kong
Pietermaritzburg Metropolitan Hospital Complex, Nelson R Mandela School of Medicine, University of KwaZulu-Natal , South Africa.
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B
Sartorius
Pietermaritzburg Metropolitan Hospital Complex, Nelson R Mandela School of Medicine, University of KwaZulu-Natal , South Africa.
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DL
Clarke
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D001064:Appendicitis / Q000150:complications* / Q000191:economics / Q000453:epidemiology* / Q000601:surgery; D003906:Developing Countries; D005260:Female; D006801:Humans; D008297:Male; D009017:Morbidity; D012189:Retrospective Studies; D012424:Rural Population; D013019:South Africa / Q000453:epidemiology; D014505:Urban Population; D055815:Young Adult
Appendicitis; Complication; Spectrum