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Short-term outcome of acute appendicitis at a rural surgical facility in Sri Lanka; a disease beyond benign simplicity

Authors:

Bingumal Jayasundara ,

District General Hospital, Nuwaraeliya District General Hospital, Nuwaraeliya,, LK
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Poornima Jayawickrama

District General Hospital, Mannar, LK
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Abstract

Introduction Acute appendicitis is the commonest intra-abdominal emergency requiring surgical intervention. The preferred treatment is appendicectomy with variable access techniques, but some patients with uncomplicated appendicitis respond well to antibiotics. Despite the benign nature of the disease, complications are not uncommon in appendicitis and after appendicectomy.

Methods: Outcome data of all cases diagnosed as acute appendicitis at District General Hospital, Mannar were prospectively collected from August 2016 to April 2017. Association between the age and duration of symptoms with the operative findings and postoperative complications were evaluated. Clavien-Dindo classification was used to grade the complications. Cases were reviewed at one month and one year.

Results: Out of 96 cases (Mean age 25.5 years, Range 7-64) diagnosed with acute appendicitis 43 were males. Eighty-three patients underwent surgery (Open appendicectomy–48, Laparoscopic appendicectomy-30, Appendicular abscess drainage-3, Midline laparotomy-2). Seventy-three (76%) and twentyt-hree (24%) cases presented with less than two and more than three days of symptoms respectively. Fifty (60.3%), twenty-eight (33.7%) and five (6%) cases had uncomplicated appendicitis, complicated appendicitis and macroscopically normal appendix as operative findings. Mean age of 30.9 years in the cases with complicated appendicitis was significantly higher than the cases with uncomplicated appendicitis (23.7 years) or ones with normal-looking appendix (22.8 years) (p=0.007 and p=0.004, post-hoc ANOVA). Mean duration of symptoms of 2.5 days noted in the cases with complicated appendicitis was significantly higher than the ones in the other groups (1.75 and 1.65 days) (p < 0.001 and p < 0.001 post-hoc ANOVA). Eighteen (21.7%), five (6%) and one (1.2%) cases had grade 1-2, grade 3-4 and grade 5 complications on Clavien-Dindo classification respectively. Mean age of 46.8 years in the cases with grade 3-5 complications was significantly higher than 24.4 years in the cases with no complications or 22 years in the ones with lesser complications (p=0.001 and p < 0.001 posthoc ANOVA). Mean duration of symptoms of cases with grade 3-5 complications (3.25 days) was higher than the rest. Sixteen of 28 (57.14%) with complicated appendicitis developed postoperative complications.

Conclusions: Within the study cohort, advanced age and prolonged symptoms were risk factors for complicated appendicitis. Advanced age was associated with severity but not the occurrence of postoperative complications in acute appendicitis. Delayed presentation and complicated appendicitis lead to post-operative complications.  

How to Cite: Jayasundara, B. and Jayawickrama, P., 2020. Short-term outcome of acute appendicitis at a rural surgical facility in Sri Lanka; a disease beyond benign simplicity. Sri Lanka Journal of Surgery, 38(2), pp.46–49. DOI: http://doi.org/10.4038/sljs.v38i2.8676
Published on 31 Aug 2020.
Peer Reviewed

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