Clinical features of acute appendicitis: A two-year study in a Surgical Unit at Korle Bu Teaching Hospital

Abstract

Acute appendicitis is one of the commonest surgical emergencies all over the world although it is less common in developing countries the incidence has been on the increase and is now known to constitute as much as 30% of all emergency general surgical emergencies in Accra. The diagnosis can sometimes be difficult to make and it may require the use of scoring systems (like the Alvarado), laboratory investigations like white cell count and creative protein, or more detailed investigations like high resolution ultrasonography, CT scan, radioisotope scan and laparoscopy. Since these are unaffordable in many developing countries, the clinical features remain the most important for making the diagnosis. The symptoms, sign and white cell count were studied in a 24-month prospective study of 156 patients with acute appendicitis at the Korle Bu Teaching Hospital. Abdominal pain (100%), vomiting 71.2%) and loss of appetite (62.2%) were the most important symptoms. The classical pain of appendicitis, which moves from the peri-umbilical region to the right iliac fossa (RIF), was present in 48.3%. Tender- ness in the RIF was the most important sign (98.7%), followed by a pulse of >80/minutes (87.2%). The white cell count was raised above 10 x 10 9 /1 in only 43.7% of the patients. Dunphy’s sign was more important than Rovsing’s sign. The appendiceal foetor was hardly recognized by any of the attending doctors.