The Clinical Relevance of Diarrhoea in Patients with Suspected Uncomplicated Appendicitis

Abstract

Background: Diarrhea is uncommon in uncomplicated appendicitis and when present, it tends to bring about delay in diagnosis, thus predisposing to complications.

Methods: This was a retrospective study of all cases of uncomplicated appendicitis seen at LAUTECH Teaching Hospital, Osogbo, Nigeria over a 3 year period.

Results: During the period under review, 153 with uncomplicated appendicitis were seen. Their ages ranged from 4 to 62 years with a median of 23.01 years. The M: F ratio was 1.15: 1. Diarrhea was more common in patients aged under 15 years (p = 0.003). Fifteen (9.8%) of the patients had diarrhea and was more common in females (12.67%) than in males (7.31%) ( p =0.201). Diarrhea was present in 4.34% and in 18.03% patients presenting before and after 72 hours respectively (p= 0.006). Fever (T >38oC) was found in 91 patients, 11 of them had diarrhoea, compared to 4 of the 62 without fever ( p= 0.283 Fisher’s exact test ). There was no significant difference in rectal findings in patients with or without diarrhea (p= 1.000). The unsuspected perforation rate was 66.6% for those with diarrhoea and 0.7% for those without diarrhea ( p<0.000, odds ratio of 274). About 22% and 5.3% of patients with and without pus collection respectively had diarrhea (p= 0.0049, O R 5.18). Diarrhea was significantly more associated with appendiceal perforation compared with simple appendicitis (p= 0.00001 odds ratio 77.5) and also compared with those with normal appendix (p =0.006). The median length of hospital stay was significantly higher in patients with diarrhea (p = 0.001)

Conclusion: Diarrhea as a symptom of appendicitis is commoner in  children. It is associated with late presentation, more perforation, intra-bdominal pus and prolonged length of stay

Key words: clinical relevance, diarrhea, appendicitis