Acute abdominal pain and appendicitis in north east Thailand

In a survey of emergency admissions to hospital in rural Thailand, acute appendicitis was the commonest cause of acute abdominal pain. Estimates of the incidence of appendicitis, in two series comprising a total of 356 patients, at 3.2 and 3.7 per 10,000 population per year, were relatively high compared with reports from other warm climate countries. In comparison with 1825 cases in studies sponsored by the Organisation Mondiale de Gastroenterologie (OMGE), Thai patients with acute appendicitis were older, presented late and experienced more complications than those in 14 other countries. In Khon Kaen only 2-3% of the cases were children aged 0-9 years, compared with 9-26% in the OMGE series. In patients admitted to hospital with acute abdominal pain in Thailand, acute appendicitis was diagnosed more often than non-specific abdominal pain. The converse was true in the OMGE series. This may reflect the longer distances travelled to hospital by many patients and delays between onset of symptoms and admission to hospital. Acute appendicitis was the commonest definitive diagnosis in both series. This survey indicates that relatively high rates of acute appendicitis may occur in populations eating traditional diets. The results are consistent with the recently described hypothesis of an infective aetiology and increases in appendicitis rates may be expected in people born since the introduction of improvements in environmental sanitation. Further studies are needed to examine trends in the incidence of appendicitis in populations eating traditional diets with both high and low fibre content and to investigate the significance of changing social and environmental factors.