Demographics of paediatric patients presenting with acute appendicitis: A 5-year retrospective review of hospitals served by the Department of Paediatric Surgery at the University of the Witwatersrand

Abstract

Background. There are no recently published data on the incidence and demographics or perforation rates of paediatric patients from our local population presenting with acute appendicitis.

Objective. To show the age and gender distribution of paediatric patients presenting with acute appendicitis within our communities, as well as demonstrating the incidence of perforated acute appendicitis in our paediatric population.

Method. The study is a retrospective record review of all paediatric patients who presented with acute appendicitis to the Department of Paediatric Surgery at both Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), and Chris Hani Baragwanath Academic Hospital (CHBAH) from June 2010 to September 2015. Data collected included all demographic data as well as histology results of patients who underwent appendectomies.

Results. The total numbers of patients included in the study were 544; 234 at CHBAH, and 311 at CMJAH. The male-to-female ratio was 1.58:1. The mean age for presentation at both hospitals combined was 8.76 years. We found that 13.41% of paediatric patients with acute appendicitis in this cohort were under the age of 6 years. A histological review showed that 50.1% of patients in our cohort presented with complicated appendicitis, and we had a negative appendectomy rate of 8.4%. Histological results of patients under the age of 6 years revealed a higher negative appendicectomy rate of 11.4%. However, the incidence of complicated appendicitis in this age group was only 45.7%, which is lower than that reported in the literature. Three patients were found to have Enterobius vermicularis in the lumen of the appendix, and Ascaris ova were identified in one patient. Histology revealed a low-grade mucinous neoplasm in one patient.

Conclusion. Acute appendicitis occurred at a median age of 8.76 years in our study population, with a male-to-female ratio of 1.58:1. We found that acute appendicitis occurred relatively more frequently in our patients under the age of 6 years compared with the incidence of acute appendicitis in this age group published elsewhere. Complicated appendicitis occurred in 50.1% of our patient population, with an increased frequency of perforated appendicitis occurring in our male population. However, complicated appendicitis occurred in only 44.7% of our patients below the age of 6 years, which is in stark contrast to published literature. Helminthic infections were rare associated pathogens in our study, and an unlikely underlying pathogen of acute appendicitis in our population.