Morbidity and Mortality Pattern of Appendicitis in Rural Teaching Hospital of Nepal

Background: Acute appendicitis is the most common cause of surgical acute abdomen. It contributes for 40 % of all emergency performed abdominal surgeries in western world and 26 % it accounts for in Nepal. Clinical diagnosis plays a vital role in appendicitis. The treatment of acute appendicitis remains a health problem and significant morbidity and mortality are still associated with it. Morbidities such as perforation, abscess formation, appendicular lump and surgical site of infection are well reported. Late arrival in hospital and use of inadequate dose of antibiotics in local might have association in increasing morbidities. The aim of the study is to observe the morbidity and mortality in appendicitis patients belonging to this region of Nepal. Methods: This cross sectional retrospective study was carried out in the Karnali academy of health sciences, Jumla. The data includes the 5 years period from June 2014 to March 2020. The parameters included admission of acute appendicitis, age, gender, post-operative findings and complication. Results: There were 186 cases collectively. 175 cases of appendicitis were recorded. The mean age was 31±15.16. Ninety two (52.6%) were female; 83(47.4%) were male. 119(68%) had appendectomies. 56(32%) were treated conservatively. 29(51.78%) were appendicular lump and 27(48.2%) were suspected appendicitis. Five were found to have perforation of appendix.  Two had abscess in 29 cases of appendicular mass. 2 had a surgical site infection.   Conclusion: Among patients who were admitted in the hospital with diagnosis of acute appendicitis, the commonest complication was the appendicular lump, which might be due to late hospital arrival or early antibiotics use impulsively at local level, followed by perforation appendix. The result supports both appendectomy and conservative treatment were equally feasible for acute appendicitis according to the cases presented in the hospital.