Tropical surgical abdominal emergencies: acute appendicitis

In a prospective 5-year investigation of acute appendicitis 603 consecutive patients with the disorder were studied in detail. Of this number 388 (64.3%) were female and 215 (35.7%) male giving a female: male ratio of 1.8:1. The patients were aged 4-65 years with a median age of 23.1 years; females with a median age of 22.1 years were younger than males with a median age of 25.4 years. Patients presented to hospital late: 3-7 days (median 5 days) from the onset of symptoms; the strikingly most common of these was abdominal pain seen in all the patients, and tenderness, local or with rebound was uniformly elicited. Supportive laboratory and radiological services were not regularly available; however, when white cell count was obtainable leucocytosis with a left shift was a useful finding. At operation 422 (70%) patients had an acutely inflamed appendix, 121 (20%) gangrenous or perforated appendicitis and 18 (3%) an appendix abscess; an appendix mass was palpable in 42 (7%) patients and these were treated conservatively. Wound infection complicated surgery in 18 (3%) patients; there were no operative deaths. Acute appendicitis was the second commonest surgical abdominal emergency during the period under study, and the results of treatment compare favourably with series from the developed countries of the West.