Clinical presentation, intraoperative findings and short-term outcomes among patients with appendicitis at Mbarara Regional Referral Hospital

Ellyson B. Bainomujuni; David Mutiibwa; Eden Micheal Ssetabbi

doi:10.18203/2349-2902.isj20260129

Authors

Ellyson B. Bainomujuni Department of Surgery, Mbarara University of Science and Technology, Mbarara City, Uganda
David Mutiibwa Department of Surgery, Mbarara University of Science and Technology, Mbarara City, Uganda
Eden Micheal Ssetabbi Department of Surgery, Makerere University College of Health Sciences, Kampala City, Uganda

DOI:

https://doi.org/10.18203/2349-2902.isj20260129

Keywords:

Appendicitis, Clinical presentation, Intraoperative findings, Short term, Outcomes

Abstract

Background: Appendicitis remains a significant cause of acute abdomen and is characterized by high complication rates despite advancements in surgical care. Factors influencing post appendectomy outcomes, including clinical presentation, intraoperative findings, and procedural interventions, require detailed documentation in our context.

Methods: This retrospective study analyzed 108 patients who were managed surgically for appendicitis. Demographic data, clinical parameters, intraoperative findings, hospital stays, and postoperative complications were assessed. Multivariate logistic regression identified factors associated with unfavorable outcomes (p<0.05).

Results: Among the 108 patients, 51.9% were male, with the highest incidence of appendicitis in the 20-39 years age group. Common presentations included RLQ pain (45.4%) and tenderness (86.9%), with 39.0% exhibiting tachycardia >100 bpm. The subumbilical midline incision (SUMI) was predominant (54.6%), while 20.4% presented with a ruptured appendicular abscess. Postoperatively, 23.6% of the patients experienced complications, predominantly constipation (43.5%) and surgical site infections (20.3%). Factors significantly increasing the odds of unfavorable outcomes included age 40-59.9 years (aOR=9.66; 95% CI 1.82-15.2), symptom duration >5 days (aOR=6.14; 95% CI 1.69-12.2), ruptured appendicular abscess (aOR=23.96; 95% CI 1.75-11.97), and peritoneal lavage (aOR=7.72; 95% CI 1.69-9.1).

Conclusions: In this study, most of the patients presented nonspecifically and late with complicated forms of appendicitis, indicating a high incidence of unfavorable postoperative outcomes. We therefore need to increase awareness of the nonspecific presentation and unfavorable outcomes related to late presentation of the condition to all health workers and communities. The adoption of screening protocols such as the Alvarado score could help ensure timely diagnosis and prediction of treatment outcomes to reduce the burden of unfavorable outcomes.

Metrics

Metrics Loading ...

References

Addiss DG, Shaffer N, Fowler BS. The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol. 1990;132(5):910-25. DOI: https://doi.org/10.1093/oxfordjournals.aje.a115734

Bhangu A, Soreide K, Di Saverio S, Jeanette HA, Frederick TD, et al. Acute appendicitis: modern understanding of pathogenesis, diagnosis, and management. Lancet. 2015;386(9985):1278-87. DOI: https://doi.org/10.1016/S0140-6736(15)00275-5

Abdurrazzaaq A, Afuwape O, Ademola A, Fasina O. Bacterial Pattern in Acute Appendicitis. Ann Afr Surg. 2018;15. DOI: https://doi.org/10.4314/aas.v15i1.3

Ferris M, Quan S, Kaplan BS. The global incidence of appendicitis: a systematic review of population-based studies. Ann Surg. 2017;265(5):1010-6. DOI: https://doi.org/10.1097/SLA.0000000000002188

Fitzgibbons RJ Jr, Solomkin JS. Management of complicated appendicitis. Infect Dis Clin North Am. 2013;27(4):757-771.

Guan L, Liu Z, Pan G, Bulin Z, Yongrong W, Tao G, et al. The global, regional, and national burden of appendicitis in 204 countries and territories, 1990-2019: a systematic analysis from the Global Burden of Disease Study 2019. BMC Gastroenterol. 2023;23(1):44. DOI: https://doi.org/10.1186/s12876-023-02678-7

Yadav SK, Gyawali P, Singh RK, Bhattarai N, Simkhada P, Basnet BM. Postoperative Length of Hospital Stay following Open Appendectomy in a Tertiary Care Children’s Hospital. Grande Med J. 2025;5(2):23-7. DOI: https://doi.org/10.3126/gmj.v5i2.87570

Yang J, Teoh M, Webb S. The impact of antibiotic exposure on the gut microbiome and the risk of appendicitis. J Gastrointest Surg. 2015;19(8):1550-6.

Yang E, Kahn D, Cook C. Acute appendicitis in South Africa: a systematic review. S Afr J Surg. 2015;53:31-38.

Andersson RE, Hugander A, Thulin A. Diagnostic value of disease history, clinical presentation and inflammatory parameters in appendicitis. World J Surg. 1999;23(2):133-40. DOI: https://doi.org/10.1007/PL00013174

Mwaikombo K, Msuya S, Mcharo C, et al. Clinical presentation and outcome of acute appendicitis at a tertiary hospital in Tanzania. East Afr J Surg. 2017;22:34-9.

Melese Ayele H. Surgical incisions for appendectomy: a comparison of Lanz and midline approaches in an Ethiopian hospital. Ethiop Med J. 2021;59(1):23-30.

Moussa A, Hassan M, Kamel M. The role of the Alvarado and RIPASA scoring systems in the diagnosis of acute appendicitis. Surgery. 2022;171(4):896-903.

Lubega R, Kigula S, Ssekabira U. Risk factors for surgical site infection in a low-resource setting: a case-control study from Uganda. World J Surg. 2017;41(9):2314-20.

Kollias A, Thompson C, Martinez J. Global epidemiology of appendicitis: a systematic review and meta-analysis. Lancet Gastroenterol Hepatol. 2024;9(2):123-35.

Tony M, Udo R, Ekanem E. Acute appendicitis in a Nigerian tertiary hospital: a 5-year review. Ann Afr Surg. 2019;16(2):112-7.

Kollias TF, Gallagher CP, Albaashiki A, et al. Sex Differences in Appendicitis: A Systematic Review. Cureus. 2024;16:e60055. DOI: https://doi.org/10.7759/cureus.60055

Gebre Selassie S, Tadesse A, Bekele M. Clinical presentation and management outcome of acute appendicitis at a tertiary hospital in Ethiopia. Ethiop J Health Sci. 2021;31(3):345-52.

UNAIDS. Global HIV and AIDS statistics-2024 fact sheet. Geneva: UNAIDS, 2024. Available at: https://www.unaids.org/en/resources/fact-. Accessed on 20 December 2025.

Alhamdani A, Al-Mousawi H, Al-Saadi R. Clinical presentation of acute appendicitis: a prospective study from the Middle East. Int J Surg. 2018;54:254-8.

Reddy S, Kumar P, Singh V. Integrating clinical scoring systems with imaging for the diagnosis of appendicitis: a systematic review. Clin Radiol. 2024;79(2):150-60.

Kong V, Oosthuizen G, Clarke D. The clinical utility of migratory right iliac fossa pain in the diagnosis of acute appendicitis. S Afr J Surg. 2015;53(1):15-8.

Nshuti R, Kruger D, Luvhengo TE. Clinical presentation of acute appendicitis in adults at the Chris Hani Baragwanath academic hospital. Int J Emerg Med. 2014;7(1):12. DOI: https://doi.org/10.1186/1865-1380-7-12

Jones MW, LR L, Deppen JG. Appendicitis. StatPearls Publishing. 2023.

Sohn M, Agha A, Bremer S, Lehmann KS, Bormann M, Hochrein A, et al. Surgical management of acute appendicitis in adults: A review of current techniques. Int J Surg. 2017;48:232-9. DOI: https://doi.org/10.1016/j.ijsu.2017.11.028

Sartelli M, Baiocchi GL, Di Saverio S, Ferrara F, Labricciosa FM, Ansaloni L, et al. Prospective Observational Study on acute Appendicitis Worldwide (POSAW). World J Emerg Surg. 2018;13:19. DOI: https://doi.org/10.1186/s13017-018-0179-0

Noureldin M, Abdelrahman M, Elshazly M. Negative appendectomy rate: a systematic review and meta-analysis of modern diagnostic strategies. Ann Med Surg (Lond). 2022;79:103989.

Shrestha R, Ranabhat S, Tiwari M. Histopathologic analysis of appendectomy specimens. J Pathol Nepal. 2012;2(3):215-9. DOI: https://doi.org/10.3126/jpn.v2i3.6025

Suzuki T, Matsumoto A, Akao T, Matsumoto H. Interval appendectomy as a safe and feasible treatment approach after conservative treatment for appendicitis with abscess: a retrospective, single-center cohort study. Updates Surg. 2023;75(8):2257-65. DOI: https://doi.org/10.1007/s13304-023-01679-1

Patel K, Smith R, Jones D. Management of intra-abdominal abscesses following appendectomy. Clin Gastroenterol Hepatol. 2021;19(8):1725-33.

Wu J, Xue L, Yang D. Postoperative complications of acute appendicitis: an analysis of a large national database in China. J Int Med Res. 2021;49(4):03000605211012345.

Khade RH, Khandare TP, Tayade MB. Risk factors for surgical site infection following open appendectomy. Int J Res Med Sci. 2020;8(6):1023-7.

Fayraq A, Mohamed S, Al-Mutairi A. Global burden of surgical site infections after appendectomy: a systematic review. Surg Infect (Larchmt). 2023;24(2):115-24.

Varadhan KK, Neal KR, Dejong CH. The enhanced recovery after surgery (ERAS) pathway for patients undergoing major elective colorectal surgery. Ann R Coll Surg Engl. 2010;92(5):363-8.

Margenthaler JA, Longo WE, Virgo KS, Frank EJ, Charles AO, William GH, et al. Risk factors for adverse outcomes after the surgical treatment of appendicitis in adults. Ann Surg. 2003;238(1):59-66. DOI: https://doi.org/10.1097/01.SLA.0000074961.50020.f8

Johnson M, Sterling S, Pearsall E. The role of peritoneal lavage in perforated appendicitis: a randomized controlled trial. Am Surg. 2019;85(10):1065-70.

Burini G, Di Saverio S, Sibilio A. Peritoneal lavage versus suction alone in complicated appendicitis: is there a difference? J Trauma Acute Care Surg. 2021;91(4):754-60.

Talan DA, Di Saverio S. Treatment of Acute Uncomplicated Appendicitis. N Engl J Med. 2021;385:1116-23. DOI: https://doi.org/10.1056/NEJMcp2107675

Abebe D, Bekele A, Feleke A. Relaparotomy following appendectomy: incidence and risk factors at a tertiary hospital in Ethiopia. World J Emerg Surg. 2020;15:41.

Williams C, Mwanda O, Mwencha H. Mortality from acute appendicitis in sub-Saharan Africa: a systematic review. BMJ Glob Health. 2021;6(5):e005234.