A study of perforated acute appendicitis at the University Teaching Hospital, Lusaka

Abstract

A prospective descriptive study of perforated appendicitis as seen at The University Teaching hospital (UTH), Lusaka, Zambia, was carried out over a period of nine months.(l^' March to 30* November 2007). The aim was to establish the appendiceal perforation rate, to describe some of the factors associated with perforated appendicitis as well as to describe the major associated early complications.The inclusion criteria were a confirmed intra operative diagnosis of perforated or non perforated appendicitis. All Patients were recruited into the study until the sample size was reached. The details of each patient were entered on an evaluation form designed for the study. Each patient was followed up for four weeks. A total of 71 appendicectomies were done. The appendiceal perforation rate was at 43.6 percent. 64.5 percent presented with generalized peritonitis necessitating laparotomy through the midline. The male to female ratio of perforation was 2.5:1. The commonest perforations were in the 30 to 40 year age group. The majority of those with perforation presented between the third and fifth days after the onset of symptoms whereas the majority of those with non-perforated acute appendicitis presented within the first forty eight hours. The main factor attributed to perforation was pre- hospital delay by the patient. 50 percent of those with perforation came from highly populated residential areas and with poor socioeconomic background and subsequent poor access to quality health care. 11 percent used traditional medicine prior to admission to UTH. There was no in-hospital delay attributed to the surgeons or surgery. Perforation was associated with high levels of morbidity with a 33.3 percent wound infection and a further 22.2 percent requiring relaparotomies for intra abdominal abscesses. The overall mortality rate was 1.4 percent.The high rate of perforated appendicitis is due to pre-hospital patients' delay, therefore, public education, specifically targeting those groups at risk, may provide a significant solution to the problem.