Mohammed Jabbar Kadhim (1)
Acute appendicitis constitutes the most common surgical emergency in children worldwide, and the clinical process is highly influenced by the differences in healthcare access, diagnostic facilities, and surgical capacity in the regions. The presence of delayed presentation, a lack of imaging modalities, and restricted surgical resources in the case of low- and middle-income countries and especially in central Iraq leads to unusual manifestations of the disease and poor outcomes. The subtle appreciation of the local epidemiology is critical to direct context-specific clinical principles and health system interventions. The proposed study will describe the clinical presentation, diagnostic issues, complication pattern, and outcome of management of pediatric patients with acute appendicitis during a period of two years in Al-Karama Teaching Hospital, one of the tertiary referral centers in the Wasit Governorate, Iraq. Our study was a prospective, observational, cohort study which would be conducted in January 2023 to December 2024, and enroll children diagnosed with acute appendicitis according to clinical, laboratory, and/or histopathological criteria. Detailed information regarding the demographic data, the presence of symptoms and their length and severity, the physical examination, the white blood cell count, the levels of C-reactive protein, the utilization of ultrasonography or other imaging, the surgical method (open or laparoscopic), the results of the surgical procedure, the histopathological check, the complications after the surgery, and the duration of the stay in the hospital were obtained. Imibibial SPSS Statistics version 28 were to be used in conducting statistical tests with descriptive statistics, chi-square tests, and non-parametric tests (Mann 2007) being used accordingly. 187 patients were considered in the study with a median age of 9.4 years and the interquartile range [IQR] of 7.1-11.8 years, where 117 (62.6) of the 187 were males. The pain in the abdomen was universal (100%), then vomiting (78.6%), then fever (64.2%), and anorexia (57.8%). The average length of time before the symptoms were presented was 48 hours (IQR: 3672). In 77 cases (41.2%), perforated appendicitis was reported to be significantly related to the symptom duration of over 48 hours (p < 0.001). The most common surgical procedure was open appendectomy (89.3% n=167) followed by laparoscopic appendectomy only applied in 20 patients (10.7) and in the non-perforated cases. The presence of a suppurative (52.4%), gangrenous (28.9%), and perforated (18.7%) subtype was confirmed in all the resected specimens. Twenty-seven point eight percent of patients were affected by postoperative complications and these were surgical site infection (18.7%), intra-abdominal abscess (6.4%), prolonged ileus (4.8%), and wound dehiscence (2.1%). The median length of stay in the hospital was 4 days (IQR: 3-6), which was much longer in perforated cases (median: 6 days vs. 3 days; p < 0.001). Pediatric appendicitis in this group of central Iraq is often complicated by perforation and postoperative morbidity, which are mainly due to the late capabilities of healthcare-seeking behavior and inadequate access to sophisticated tests and minimally invasive procedures. These results highlight the urgent necessity to improve the level of community education, improve the frontline diagnostic capacities (e.g. point-of-care ultrasound), and invest in surgical education regarding laparoscopic techniques. Incorporating national child health measures on standardized appendicitis into the national strategy of Iraq would adhere to Sustainable development goal 3 (Good Health and Well-being) and potentially impact a considerable decrease in the morbidity and healthcare burden of preventable illness in pediatric surgery.
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