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 Table of Contents  
EDITORIAL
Year : 2017  |  Volume : 2  |  Issue : 1  |  Page : 1-2

Is acute appendicitis still the most common abdominal surgical emergency


Department of Surgery, Barau Dikko Teaching Hospital/College of Medicine, Kaduna State University, Kaduna, Nigeria

Date of Web Publication13-Sep-2017

Correspondence Address:
Jerry Godfrey Makama
Department of Surgery, Barau Dikko Teaching Hospital/College of Medicine, Kaduna State University, Kaduna
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/archms.archms_40_17

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How to cite this article:
Makama JG. Is acute appendicitis still the most common abdominal surgical emergency. Arch Med Surg 2017;2:1-2

How to cite this URL:
Makama JG. Is acute appendicitis still the most common abdominal surgical emergency. Arch Med Surg [serial online] 2017 [cited 2018 Feb 19];2:1-2. Available from: http://www.archms.org/text.asp?2017/2/1/1/214563



Acute appendicitis is said to be the most common abdominal surgical emergency that reports to a general surgeon, and it is said to occur in all ages including fetus. The incidence of appendicitis is quoted as 86 cases per 100,000 patients worldwide.[1] In low-income countries (LICs), the specific incidence rate is not well known but appears to be much lower than in high-income countries (HICs). The incidence rate in LICs varies from country to country, and in a country, it also varies by geographical region, sex, age, and by season.[2] In Nigeria, Ahmed et al.[1] reported an incidence of 2.6 per 100,000 per annum, probably the lowest rate, in northern Nigeria following an exhaustive review of data as well as the national census figures of 2006. The prevalence in developed countries is gradually declining while that of LICs appears to be rising. Many studies [1],[2] in LICs have reported a gradual rise in the prevalence of appendicitis in the recent time. In Nigeria, Alatise and Ogunweide [2] have quoted the prevalence of acute appendicitis in the Western part of Nigeria to be 15%–40%. There are so many reasons for this gradual rise in acute appendicitis in the LICs. Some of the reasons advanced in the past include a gradual change in dietary habit to that of a westernized diet. Acute appendicitis is a known abdominal surgical emergency, not only in Nigeria but also worldwide.

Another disease in the LICs that often presents with abdominal surgical emergency is perforated typhoid. Typhoid fever is a severe febrile illness caused primarily by the Gram-negative bacillus  Salmonella More Details enteritidis serovar Typhi. Even though it is a global health problem, it has been shown to have greater and devastating impact on resource-poor countries including Nigeria.[3] Many reasons have been put forward as being responsible for this. Some of these reasons include near absent supply of clean or portable water; an unhealthy environment that is characterized by dirty/poor water drainages; filthy environment due to indiscriminate open defecation; and/or very unhygienic food preparation. These regions with contaminated water supplies and inadequate waste disposal have a high incidence of typhoid fever. In general, complication rates are also high due to delayed presentation; indiscriminate use of antibiotics associated with high prevalence of multidrug-resistant S. typhi. It is further thought that the presence of highly virulent serotype in places such as Nigeria further increases the complication rate.[4] Among these complications, typhoid intestinal perforation is the most common and the most serious condition that leads to mortality closely followed by gastrointestinal bleeding. The overall incidence rate of typhoid intestinal perforation in LICs is not well known, but many scholars including Contini [3] have reported values that are much higher than those that have been reported in HICs. For instance, the incidence of typhoid fever in southeastern Turkey ranges from 210 to 320 cases per 100,000 population.[5]

Although typhoid is common all over the developing world, a patient is more likely to perforate his gut in some countries than in others. It has been reported that in areas where perforation is common, it is one of the most common causes of an acute abdomen. Over 90% of patients, many of them children perforate outside hospital.

In Nigeria, in addition to the high prevalence of the disease, there are many sociocultural factors that post a great challenge compounded by availability of diagnostic facilities with inherent limitations; delay patient transfer to appropriate facilities that have expertise to manage such complications; frequent use of subtherapeutic antibiotics, thereby encouraging the development and increased prevalence of multidrug resistance bacteria. Some other scholars have reported the presence of highly virulent subserotype of S. typhi as the cause of this risen trend in typhoid perforation. The delay in accessing relevant care is thought to also contribute to the risen trend of typhoid perforation.

These two conditions, acute appendicitis and typhoid perforation, are so common in Nigeria and often present as an abdominal surgical emergency, thus leaving surgeons to wonders if acute appendicitis is still the most common surgical emergency in Nigeria. Considering the current trend, it is doubtful if acute appendicitis is still the most common abdominal surgical emergency in Nigeria. Therefore, there is a need for a more comprehensive, widely collected data to further elucidate the present trend.



 
  References Top

1.
Ahmed SA, Makama JG, Mohammed U, Sanda RB, Shehu SM, Ameh EA. Epidemiology of appendicitis in Northern Nigeria: A 10-year review. Sub Saharan Afr J Med 2014;1:185-90.  Back to cited text no. 1
    
2.
Alatise OI, Ogunweide T. Acute appendicitis: Incidence and management in Nigeria. IFEMED J 2008;14:66-70.  Back to cited text no. 2
    
3.
Contini S. Typhoid intestinal perforation in developing countries: Still unavoidable deaths? World J Gastroenterol 2017;23:1925-31.  Back to cited text no. 3
    
4.
Ugwu BT, Yiltok SJ, Kidmas AT, Opaluwa AS. Typhoid intestinal perforation in north central Nigeria. West Afr J Med 2005;24:1-6.  Back to cited text no. 4
    
5.
Antillón M, Warren JL, Crawford FW, Weinberger DM, Kürüm E, Pak GD, et al. The burden of typhoid fever in low- and middle-income countries: A meta-regression approach. PLoS Negl Trop Dis 2017;11:e0005376.  Back to cited text no. 5
    




 

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