Identification of deficits in appendicitis diagnostic variables in females in South Africa --a descriptive study

Background: Acute appendicitis (AA) is a common surgical emergency and misdiagnosis in females is common given the potential broad differential diagnosis. There is a paucity of data on AA misdiagnosis in developing countries. Therefore, this study aims to describe the routine workup of females with...

Full description

Saved in:
Bibliographic Details
Published inSouth African journal of surgery Vol. 62; no. 2; p. 216
Main Authors Kariem, N, Owolabi, E.O, Bougard, H, Kariem, M, Gouws, J, Noor, F, Chu, K.M
Format Journal Article
LanguageEnglish
Published Medpharm Publications 01.06.2024
Subjects
Appendicitis
CT imaging
Developing countries
Diagnostic imaging
Medical records
Surgeons
South Africa
Online AccessGet full text

Cover

More Information
Summary:Background: Acute appendicitis (AA) is a common surgical emergency and misdiagnosis in females is common given the potential broad differential diagnosis. There is a paucity of data on AA misdiagnosis in developing countries. Therefore, this study aims to describe the routine workup of females with suspected AA at a South African government hospital and identify factors associated with AA misdiagnosis. Methods: This was a retrospective review of the medical records of all females older than 12 years operated on by general surgeons with a suspected diagnosis of AA over a two-year period. Demographic and clinical data, including examinations and investigations were extracted and analysed using descriptive and inferential statistics. Results: A total of 180 females were included, and 48 (26.7%) of them were misdiagnosed with AA. Of the misdiagnosed, 22 (46%) had pelvic inflammatory disease, 15 (31%) had a normal appendix, 10 (21%) had ovarian cysts, and one (2%) had endometriosis. Gynaecologic bimanual examination was performed in 123 (68.3%) patients. Twelve (6.7%) patients had a computed tomography scan, and 16 (8.9%) had an abdominal ultrasound. The absence of nausea, vomiting, and anorexia (OR = 2.43; p = 0.023), the presence of cervical excitation tenderness (OR = 4.32; p = 0.009), and adnexal tenderness (OR = 3.06; p = 0.021) were independent predictors of misdiagnosed AA. Conclusion: One in four of our participants was misdiagnosed. We recommend the routine use of clinical parameters and diagnostic imaging to improve the diagnostic accuracy of AA. In resource-limited settings, point-of-care ultrasound should also be considered. Keywords: appendicitis, misdiagnosis, South Africa, appendectomy
ISSN:0038-2361
DOI:10.36303/SAJS.00162