Acute appendicitis in childhood: Experience in a developing country
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 evidence suggesting that 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 postmortem 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.