Acute Appendicities in the Reference Health Center of Municipality II of Bamako District

This was a prospective study from January 2019 to December 2019 in the reference health center of municipality II of the Bamako district. During this period, we operated on 73 patients for acute appendicitis, including 51 men and 22 women, for a sex ratio of 1.7. The average age was 25.5 with extremes of 1 and 40 years. Abdominal pain was the main reason for consultation. The physical signs were dominated by the positivity of the Blumberg sign in 97.3% of the cases, the defense of the right iliac fossa in 79.5%, and the Rovsing sign in 61.6% of the cases. This physical examination made it possible to make the diagnosis in the majority of cases. In the face of some doubtful cases, we requested an abdominal ultrasound. Locoregional anesthesia was the most used anesthesia technique at 72.6%. The classic anterograde appendectomy with stump burial by Mac Burney was the most commonly used technique, respectively. The postoperative consequences were straightforward in 87.6%. Ana-tomopathology examination was performed on 69 surgical specimens and 4 appendectomy specimens were not subjected to an anatomo-pathological examination. Phlegmonous appendicitis was the most common at 63% of cases. Appendicitis remains the most common surgical emergency in a com-munity setting. The early diagnosis and the speed of treatment guarantee im-provements in the prognosis. The treatment is mainly surgical.


Introduction
Acute appendicitis is an acute inflammation of the ileocecal appendix, which is a surgical emergency [1]. This pathology occupies an important place in digestive surgical emergencies by its frequency.
It is seen mostly in young people and children, but not exclusively. Its diagnosis is essentially clinical despite the diagnostic criteria of Alvarado and Saint Jones [2]. There is no anatomo-clinical parallelism. The essential prognostic factor is the time elapsed between the onset of clinical signs and treatment [3].
Its etiology is multifactorial. Diagnostic errors still persist today. A 2001 American study reports that in 15.5% of cases, the appendix is normal during surgery and this rate can reach up to 45% in certain subgroups such as women of childbearing age, the elderly and children [4]. More than 6000 child and adult patients were operated on for appendicitis in France in 2014, and this pathology remains one of the most frequent that any visceral and digestive surgeon will encounter during his professional life [5]. In Nigeria in 2004, it accounted for 38.9% of abdominal surgeries and 4.4% in the same year in Niger [6].
The hospital frequency of acute appendicitis found in Mali: A study carried out at the Gabriel Touré Hospital in 2003 showed that it accounted for 28.77% of surgical emergencies and 37.4% of acute abdomens [7].
Despite the frequency of this disease in daily digestive surgery, no prior study had been carried out at the Reference Health Center of Commune II (CSRéf CII) in the district of Bamako and with the aim of updating the data. We intend to conduct this study there, the objectives of which were to determine the frequency; to describe the socio-demographic, clinical, paraclinical, therapeutic and anatomo-pathological aspects; to analyze the postoperative consequences of acute appendicitis.

Methodology
This was a one-year prospective study from 1 January to 31 December 2019 in the general surgery department of the commune II reference health centre (CS Réf C II) in the district of Bamako. We counted 73 patients during our study period who met the inclusion criteria. The patients came on their own, or were referred by other health facilities in commune II or other communes in the district of Bamako.
The following were included:

Results
During the study period, we recorded 556 consultations and 218 hospitaliza- 64.4% of our patients were referred by a health worker. The socio-economic level was low in 45%. The different professions of our patients are in Table 1 The disease progressed within 1 -3 days with an average duration of 2 days with extremes 1 -5 days. Abdominal pain represented 100% of the reasons for consultations. The pain was located in the right iliac fossa in 80.8% of cases. In 53, 4% of the cases the pain was rated at 5 or moderate pain. In 63% of cases, the appendix was phlegmonous on pathological examination.
We did not find a link between the intraoperative diagnosis and the result of the ultrasound.
There was a relationship between intraoperative diagnosis (AnaPath form) and postoperative complications. Early postoperative complications such as parietal suppurations occurred in appendicular peritonitis, i.e. 6.8% followed by appendicular abscess, or 2.7% of cases.
In AnaPath, phlegmonous appendicitis was the most prevalent with 63% of cases and the age groups 1 -15 and 16 -35 years had the same number of observations with a frequency of 47.9%. Complicated forms were observed in 38.4% when the disease progressed for 4 days or more; 50% of these complicated forms were appendicular abscess and 33% were appendicular peritonitis. When it progressed for 3 days there were 27.2% of complicated forms of which 66% were appendicular abscess.
There is an association between the clinical forms and the duration of the disease in our

Comments
During our study period, appendectomy occupied 35.0% of surgeries, i.e. the first surgery followed by hernias. It represented 72.2% of surgical emergencies.
This result is comparable to that of the systematic review by Sobnach [8] in South Africa. Gender is not a risk factor in the general literature. The male sex was the most represented with a frequency of 69.9%, i.e. a sex ratio of 1.7; this notion has been demonstrated by several authors [9] [10]. In the literature, appendicitis is pathology in young people, but it can occur at any age of life, its frequency is low at the extreme ages of life [1]. The average age in our series was 25.5 years with ranges of 1 -57 years. The 16 -35 age group was the most represented, at 61.6%. The mean age of our patients is comparable to the result of Oguntola et al. [9]. In appendicitis pain is the primary reason for patient consultation; it was the main functional sign in all patients. This pain was associated with other signs including vomiting and nausea with rates of 54.8% and 23.3% respectively in our series. Pain was found in IDF in 80.8% of patients, this rate is comparable to that of CHAVDA in Kenya in 2005 [11]. Three signs are essential to the diagnosis: Blumberg's sign is present in 50% of cases; Rovsing's sign which is not of too much clinical importance and defense in the right iliac fossa, the absence of defense should lead to doubt the diagnosis of appendicitis in the laterocecal position but does not rule out appendicitis in pelvic or retro cecal position [12]. CBC: The blood count was carried out in 63 of our patients, i.e. 86.3%, it objectified a neutrophilic hyperleukocytosis in all these patients. All patients received postoperative analgesia.
All of our patients were on a diet; their basic hydroelectrolyte needs were met by rehydration before the operation. We performed antibiotic prophylaxis 1 hour before the incision. All of our patients were put on postoperative antibiotic therapy except for catarrhal appendicitis. Appendectomy was performed in all of our patients. The postoperative consequences were straightforward in 86.3%.
Morbidity was dominated by parietal suppurations with a frequency of 11% of cases. These parietal suppurations concerned appendicular peritonitis, one case of appendicular abscess on unmonitored HIV site that we diagnosed in this circumstance, and two cases of appendicular plastron abscess. Our rate is statistically higher than that of Champault in 2008 in France (chi-square of Yates = 1.13, p = 0.28) which was found in a series of 2074 patients with morbidity of 4.5% and that of laparoscopic surgery. Besides, some authors have reported a stump fistula; 5th-day syndrome; thrombosis of the ileocolic vein [13].

Conclusion
Acute appendicitis remains the most frequent surgical emergency in commune II of the district of Bamako. It is pathology of young adults but can be found at all ages of life. Its symptomatology is polymorphic. His diagnosis is clinical.
There is an absence of anatomy clinical parallelism. Confirmation is histological.
It is pathology with low morbidity and mortality, subject to early diagnosis and surgical treatment. The standard treatment for acute appendicitis is laparoscopic appendectomy.