The Continuing Challenge of Acute Appendicitis

Acute Surgical Admissions for Abdominal Pain in Adults in Kumasi, Ghana

“…Today it is the most common acute abdominal condition reported from many centres in West Africa 1,7,14–16 . The difficulties associated with the diagnosis of acute appendicitis are well known 17–21 . In this series the negative appendicectomy rate of 25% is similar to rates of 15–30% reported by other investigators 22–25 .…”

“…1,7,[14][15][16] The difficulties associated with the diagnosis of acute appendicitis are well known. [17][18][19][20][21] In this series the negative appendicectomy rate of 25% is similar to rates of 15-30% reported by other investigators. [22][23][24][25] The high rate of negative appendicectomies is because of the difficulties in making an accurate preoperative diagnosis.…”

“…In this series the negative appendicectomy rate of 25% is similar to rates of 15–30% reported by other investigators 22–25 . The high rate of negative appendicectomies is because of the difficulties in making an accurate preoperative diagnosis 17–21 . In our environment, some tropical enteric infections and infestations such as salmonelosis of the terminal ileum and amoebiasis of the ceacum might be mistaken for acute appendicitis 7 .…”

“…[22][23][24][25] The high rate of negative appendicectomies is because of the difficulties in making an accurate preoperative diagnosis. [17][18][19][20][21] In our environment, some tropical enteric infections and infestations such as salmonelosis of the terminal ileum and amoebiasis of the ceacum might be mistaken for acute appendicitis. 7 In young women, a high negative appendicectomy rate is often accepted because of the presence of gynaecological conditions, which may mimic appendicitis.…”

Decline in admission rates for acute appendicitis in England

“…Langman17 suggested that the decline in admission rates for acute appendicitis in England and Wales between the 1950s and the 1970s, accompanied by a concomitant increase in admissions for abdominal pain of uncertain cause, might in part be the result of reclassification. The importance of early recognition and treatment of perforated appendicitis has traditionally been emphasized, so in doubtful cases surgeons felt obliged to operate without delay18. More recently the entity of acute non‐specific abdominal pain was recognized, and a regimen of active observation described19–21, for patients presenting with symptoms and signs compatible with acute appendicitis but then settling over the next few hours.…”