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Misdiagnosis of Appendicitis in Women in a Resource Limited Setting: Lessons from South Africa
Introduction: Acute appendicitis (AA) is a common surgical emergency. In low and middleincome countries, the diagnosis is often made clinically due to the lack of access to specialised imaging. Misdiagnosis in females is common, given the potential broad differential diagnosis. The rate of misdiagno...
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| Format: | Thesis |
| Language: | English |
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Division of General Surgery
2024
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| _version_ | 1867613199355871232 |
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| access_status_str | Open Access |
| author | Kariem, Nazmie |
| author2 | Chu, Kathryn |
| author_browse | Chu, Kathryn Kariem, Nazmie |
| author_facet | Chu, Kathryn Kariem, Nazmie |
| author_sort | Kariem, Nazmie |
| collection | Thesis |
| description | Introduction: Acute appendicitis (AA) is a common surgical emergency. In low and middleincome countries, the diagnosis is often made clinically due to the lack of access to specialised imaging. Misdiagnosis in females is common, given the potential broad differential diagnosis. The rate of misdiagnosis varies between countries, but there is a paucity of data in the developing world. The aim and objectives of this study were to describe the routine workup of females with suspected AA at a South African government hospital and to determine factors associated with the misdiagnosis of AA. Methods: A retrospective review of all females older than 12 years operated on by general surgeons with a suspected diagnosis of AA over a 2-year period was reviewed. Data including age, gender, presenting complaints and physical findings, laboratory and radiological results, pre and post-operative diagnoses were extracted and analysed using descriptive and inferential statistics. Results: A total of 180 females were included and 48 (26.7%) of them were misdiagnosed with AA. Of these 48 that were misdiagnosed, 22 (46%) had pelvic inflammatory disease (PID), 15 (31%) had a normal appendix, 10 (21%) had ovarian cysts and (2%) had endometriosis. Gynaecologic bimanual examination was performed in 123 (68.3%) patients. Twelve (6.7%) patients had a CT scan and 16 (8.9%) had an abdominal ultrasound. In the multivariate model, the absence of nausea, vomiting and anorexia (odds ratio (OR)=2.43; p=0.023), the presence of cervical excitation tenderness (CET) (OR: 4.32; p=0.009) and adnexal tenderness (OR=3.06; p=0.021) were significantly associated with a diagnosis other than appendicitis. These factors remained significant in the multivariate model after adjusting for relevant covariates. Conclusion: More than 25 % of females referred to general surgeons with suspected AA were misdiagnosed. Since imaging is not accessible at most resource-limited settings, it is imperative to conduct a gynaecologic examination on every female since adnexal and cervical tenderness were associated with PID and not AA. |
| format | Thesis |
| id | oai:open.uct.ac.za:11427/39574 |
| institution | University of Cape Town (South Africa) |
| language | eng |
| last_indexed | 2026-06-10T12:32:20.328Z |
| license_str | Not specified — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from UCTD — University of Cape Town Open Access Repository |
| publishDate | 2024 |
| publishDateRange | 2024 |
| publishDateSort | 2024 |
| publisher | Division of General Surgery |
| publisherStr | Division of General Surgery |
| record_format | dspace |
| source_str | UCTD — University of Cape Town Open Access Repository |
| spelling | oai:open.uct.ac.za:11427/39574 Misdiagnosis of Appendicitis in Women in a Resource Limited Setting: Lessons from South Africa Kariem, Nazmie Chu, Kathryn General Surgery Introduction: Acute appendicitis (AA) is a common surgical emergency. In low and middleincome countries, the diagnosis is often made clinically due to the lack of access to specialised imaging. Misdiagnosis in females is common, given the potential broad differential diagnosis. The rate of misdiagnosis varies between countries, but there is a paucity of data in the developing world. The aim and objectives of this study were to describe the routine workup of females with suspected AA at a South African government hospital and to determine factors associated with the misdiagnosis of AA. Methods: A retrospective review of all females older than 12 years operated on by general surgeons with a suspected diagnosis of AA over a 2-year period was reviewed. Data including age, gender, presenting complaints and physical findings, laboratory and radiological results, pre and post-operative diagnoses were extracted and analysed using descriptive and inferential statistics. Results: A total of 180 females were included and 48 (26.7%) of them were misdiagnosed with AA. Of these 48 that were misdiagnosed, 22 (46%) had pelvic inflammatory disease (PID), 15 (31%) had a normal appendix, 10 (21%) had ovarian cysts and (2%) had endometriosis. Gynaecologic bimanual examination was performed in 123 (68.3%) patients. Twelve (6.7%) patients had a CT scan and 16 (8.9%) had an abdominal ultrasound. In the multivariate model, the absence of nausea, vomiting and anorexia (odds ratio (OR)=2.43; p=0.023), the presence of cervical excitation tenderness (CET) (OR: 4.32; p=0.009) and adnexal tenderness (OR=3.06; p=0.021) were significantly associated with a diagnosis other than appendicitis. These factors remained significant in the multivariate model after adjusting for relevant covariates. Conclusion: More than 25 % of females referred to general surgeons with suspected AA were misdiagnosed. Since imaging is not accessible at most resource-limited settings, it is imperative to conduct a gynaecologic examination on every female since adnexal and cervical tenderness were associated with PID and not AA. 2024-05-02T09:17:24Z 2024-05-02T09:17:24Z 2023 2024-05-02T08:27:34Z Thesis / Dissertation Masters MMed http://hdl.handle.net/11427/39574 eng application/pdf Division of General Surgery Faculty of Health Sciences |
| spellingShingle | General Surgery Kariem, Nazmie Misdiagnosis of Appendicitis in Women in a Resource Limited Setting: Lessons from South Africa |
| thesis_degree_str | Master's |
| title | Misdiagnosis of Appendicitis in Women in a Resource Limited Setting: Lessons from South Africa |
| title_full | Misdiagnosis of Appendicitis in Women in a Resource Limited Setting: Lessons from South Africa |
| title_fullStr | Misdiagnosis of Appendicitis in Women in a Resource Limited Setting: Lessons from South Africa |
| title_full_unstemmed | Misdiagnosis of Appendicitis in Women in a Resource Limited Setting: Lessons from South Africa |
| title_short | Misdiagnosis of Appendicitis in Women in a Resource Limited Setting: Lessons from South Africa |
| title_sort | misdiagnosis of appendicitis in women in a resource limited setting lessons from south africa |
| topic | General Surgery |
| url | http://hdl.handle.net/11427/39574 |
| work_keys_str_mv | AT kariemnazmie misdiagnosisofappendicitisinwomeninaresourcelimitedsettinglessonsfromsouthafrica |