رسائل دكتوراة
English
2016
Prevalence of Late Presentation of Acute Appendicitis in Wad Medani Teaching Hospital Gezira State Sudan (2012 – 2014)
Magd Eldin Ahmed Ali, Mustafa Idris Mohamed , Qasem Abdulkareem Qasem Alyhari
كلية الطب-جامعة الجزيرة · السودان
Acute appendicitis is the most common cause of an ‘acute abdomen’ in young adults. Delay in diagnosing appendicitis increases the risk of perforation and complications. Although there is considerable variability, perforation typically occurs after at least 48 hours from the onset of symptoms and is accompanied by an abscess cavity walled-off by the omentum and small intestine (appendicular mass). This study was undertaken to know the prevalence of late (who presented after 48 hours) presentation of acute appendicitis in Sudanese patients. It is a retrospective study of cases who presented late with history of acute appendicitis, at Wad Madani Teaching Hospital from a period of January 2012 to December 2013. Total numbers of patients were 758 presented with history of acute appendicitis. The patient who came late are 25% (191). The highest incidence noticed in this study between ages 15-30 years which constitute 47.6% of the patients. High male predominance (64%)was noticed in our study. More than half of the patients have low educational level. The bulk of the patients in our study live in rural area 82%. The first cause of delayed presentation of acute appendicitis were misdiagnosis 65% of cases, and of these misdiagnosed patients 53% were seen by general practitioner and physician, 44% of them seen by medical assistant and nurse, and only 3% of them taking drugs from pharmacist without consultation. The second cause was ignorance (about 19%), and last cause 16% treated traditionally. The misdiagnosed cases were diagnosis as medical cases rather than surgical cases distributed as 23.4% as malaria, 21% as typhoid, 22.6% as gastroenteritis, 13.7% as pelvic inflammatory disease, 12.1% as urinary tract infection. When patients presented to us were in late stage of complications, near half 46% of patients presented as appendicular mass 89% of them treated conservatively, and about 11% failed conservative management this percent divided as 4.5% developed appendicular abscess underwent drainage of the abscess and 6.5% developed peritonitis and laparotomy were done. 25% of cases presented as peritonitis due to perforated appendix underwent laparotomies, 8% as appendicular abscess underwent drainage of abscess, and 21% still in acute appendicitis stage underwent appendectomy. In patients who went to surgery the post-operative complications were high (16%). Most of these complications (83%) were wound infection. Time stayed in hospital more than half of patients 55% stayed from 3-5 days, 27% stayed more than 5 days, and only 18% discharge before three days. At the end of this study our recommendations to medical personnel in to raise their suspicion of these emergencies so as not to miss them and increase the diagnosis accuracy and increase awareness of the risk of appendicitis both public and medical field is essential to reduce the number of complicated appendicitis. Also we need much more proper system of prescribing drugs and their issue by pharmacist is urgently needed to avoid drugs abuse. We suggest that health center in rural area have doctor with reasonable surgical experience.
