IIARD International Institute of Academic Research and Development

INTERNATIONAL JOURNAL OF MEDICAL EVALUATION AND PHYSICAL REPORT (IJMEPR )

E-ISSN 2579-0498
P-ISSN 2695-2181
VOL. 9 NO. 2 2025
DOI: 10.56201/ijmepr.v9.no2.2025.pg46.52

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Complicated Appendicitis in Adults: Experiences in a Tertiary Care Institution in Southern Nigeria

Promise Nnamdi Wichendu, and Michael Ekemena Ogba

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Abstract

Background: Appendicitis, characterised by inflammation of the appendix, is a common surgical emergency encountered worldwide, imposing a substantial burden on the healthcare system. Complicated appendicitis refers to cases where the inflammation progresses to perforation, abscess formation, or other intra-abdominal complications, often requiring more extensive surgical procedures, increased hospital stays, and heightened resource utilisation. This study aims to elucidate the factors predisposing to complicated appendicitis to create awareness, ameliorate its occurrence, and optimise patient outcomes. Methodology: A retrospective study was conducted. Patients who had appendicectomies between January 2018 and December 2022 were included in the study. Data were collected and analysed using the Statistical Package for Social Sciences (SPSS), version 26. Results: Out of the total of 92 participants, 45 (48.9%) were male, and 47 (51.1%) were female. The male: female ratio was 1:1.04. The majority of patients (92.4%) were between the ages of 10-39yrs with the highest age category being 20-29 years (48.9%). The mean duration of symptoms of patients with complicated cases was 6 days (range: 1 – 21 days). In contrast, participants with uncomplicated cases had a mean of 3 days (range: 8 hours to 8 days). Complicated cases had an average stay of 9 days (range: 5-19 days). Participants with uncomplicated cases had a mean duration of 4 days (range: 3-7 days) Conclusion: Complicated appendicitis exhibits distinct presentation patterns and outcomes. This study emphasises the importance of early recognition and prompt surgical intervention to reduce the morbidity and mortality associated with complicated appendicitis.

complicated appendicitis, retrospective study, tertiary care institution, southern Nigeria, diagnostic imaging, surgical management, complications, outcomes.

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References:

Balogun OS, Osinowo A, Afolayan M, Olajide T, Lawal A, Adesanya A. Acute perforated
appendicitis in adults: Management and complications in Lagos, Nigeria. Ann Afr Med.
2019;18(1):36.
Tan WJ, Acharyya S, Goh YC, Chan WH, Wong WK, Ooi LL, et al. Prospective comparison
of the Alvarado score and CT scan in the evaluation of suspected appendicitis: a proposed
algorithm to guide CT use. J Am Coll Surg. 2015;220(2):218–24.
Duduyemi BM. Clinicopathological review of surgically removed appendix in Central
Nigeria. Alexandria Journal of Medicine. 2015;51(3):207–11.
Di Saverio S, Birindelli A, Kelly MD, Catena F, Weber DG, Sartelli M, et al. WSES
Jerusalem guidelines for diagnosis and treatment of acute appendicitis. World Journal of
Emergency Surgery. 2016;11(1):1–25.
Deiters A, Drozd A, Parikh P, Markert R, Shim JK. Use of the Alvarado score in elderly
patients with complicated and uncomplicated appendicitis. Am Surg. 2019;85(4):397–402.
Petroianu A. Diagnosis of acute appendicitis. International Journal of Surgery.
2012;10(3):115–9.
Duke E, Kalb B, Arif-Tiwari H, Daye ZJ, Gilbertson-Dahdal D, Keim SM, et al. A
systematic review and meta-analysis of diagnostic performance of MRI for evaluation of
acute appendicitis. American Journal of Roentgenology. 2016;206(3):508–17.
Edino ST, Mohammed AZ, Ochicha O, Anumah M. Appendicitis in Kano, Nigeria: A 5-year
review of pattern, morbidity and mortality. 2004;
Guercio G, Augello G, Licari L, Dafnomili A, Raspanti C, Bagarella N, et al. Acute
appendicitis: should the laparoscopic approach be proposed as the gold standard? Six-year
experience in an Emergency Surgery Unit. Il Giornale di Chirurgia-Journal of the Italian
Surgical Association. 2016;37(4):174–9.
Bahram MA. Laparoscopic appendectomy: Is it the gold standard approach for management
of acute appendicitis? World Journal of Laparoscopic Surgery. 2010;7(3):116–20.
Bhangu A, Søreide K, Di Saverio S, Assarsson JH, Drake FT. Acute appendicitis: modern
understanding
of
pathogenesis,
diagnosis,
and
management.
The
Lancet.
2015;386(10000):1278–87.
Moris D, Paulson EK, Pappas TN. Diagnosis and management of acute appendicitis in
adults: a review. JAMA. 2021;326(22):2299–311.
de Almeida Leite RM, de Souza AV, Bay CP, Cauley C, Bordeianou L, Goldstone R, et al.
Delayed operative management in complicated acute appendicitis—is avoiding extended
resection worth the wait? Results from a global cohort study. Journal of Gastrointestinal
Surgery. 2022;26(7):1482–9.
Haque MM. Management Strategies for Complicated Appendicitis: A Review of Surgical
Techniques. Sch J App Med Sci. 2024;8:1103–9.
Aji N, Aliyu S. Appendicitis and its surgical management experience at the University of
Maiduguri Teaching Hospital Nigeria. Nigerian Journal of Medicine. 2012;21(2):223–6.
Alatise OI, Ogunweide T. Acute appendicitis: Incidence and management in Nigeria.
Journal of the Obafemi Awolowo University Medical Student’s Association (IFEMED).
2008;14(1):66–70.
Offobo SN, Nyamatsiengui H, Aseke KJA, Choua O. The Epidemiological Profile of Acute
Appendicitis, about 124 Cases, in the General Surgery Department of the Amissa Bongo
Regional Hospital Center in Franceville, Gabon. Surg Sci. 2022;13(6):317–26.
Sharma P, Chhari AS, Singh AP. Clinico-Pathological Study of Appendicitis in a Tertiary
Center in Vindhya Region, Madhya Pradesh, India. Int J Res Med Sci. 2016;4(7):2914–20.
Malaekah H, Makhdoom F, Almedbal H, Aggarwal R. Acute Appendicitis Pathways: A
Systemic Review. Surg Sci. 2021;12(5):143–59.
Njoku TA, Okobia MN. Perforated appendicitis: Risk factors and outcomes of management.
Nigerian Journal of Surgical Sciences. 2006;16(2):76–9.
Khanapure S, Nagral S, Nanavati AJ. A study of events between the onset of symptoms and
hospital admission in patients with acute abdomen. Natl Med J India. 2017;30(2):65.
Chung CH, Ng CP, Lai KK. Delays by patients, emergency physicians, and surgeons in the
management of acute appendicitis: retrospective study. Hong Kong Medical Journal.
2000;6(3):254–9.
Mustafa MI, Abbas M. A study of factors responsible for delayed presentation of acute
appendicitis and their implications on the outcome. Pak J Med Health Sci. 2008;2:15–9.
Augustin T, Cagir B, VanderMeer TJ. Characteristics of perforated appendicitis: effect of
delay is confounded by age and gender. Journal of Gastrointestinal Surgery. 2011;15:1223–
Bröker MEE, van Lieshout EMM, van der Elst M, Stassen LPS, Schepers T. Discriminating
between simple and perforated appendicitis. Journal of Surgical Research. 2012;176(1):79–
Lin CJ, Chen JD, Tiu CM, Chou YH, Chiang JH, Lee CH, et al. Can ruptured appendicitis
be detected preoperatively in the ED? Am J Emerg Med. 2005;23(1):60–6.
Kim TH, Cho BS, Jung JH, Lee MS, Jang JH, Kim CN. Predictive factors to distinguish
between patients with noncomplicated appendicitis and those with complicated
appendicitis. Ann Coloproctol. 2015;31(5):192.
Dodiyi-Manuel A, Koroye OF. Appendicitis in University of Port Harcourt Teaching
Hospital, Nigeria. East Afr Med J. 2012;89(10):327–31.
Khan J, Ali A, Sarwar B. Causes of Delayed presentation of acute appendicitis and how it
affects morbidity and mortality. Journal of Saidu Medical College, Swat. 2018;8(1).
Kidwai R, Sharma A. Acute perforated appendicitis: clinical profile and analysis of risk
factors. Journal of Nepalgunj Medical College. 2018;16(2):13–5.
Kim JW, Shin DW, Kim DJ, Kim JY, Park SG, Park JH. Effects of timing of appendectomy
on the risks of perforation and postoperative complications of acute appendicitis. World J
Surg. 2018;42:1295–303.
Ming PC, Yan TYY, Tat LH. Risk factors of postoperative infections in adults with
complicated appendicitis. Surg Laparosc Endosc Percutan Tech. 2009;19(3):244–8.

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