Demographical Study of Appendicitis Patients in Basra/Iraq



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Submitted May 24, 2024
Published Jul 8, 2024
10.24018/ejmed.2024.6.4.2136

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Background. Acute appendicitis is a prevalent cause of severe lower abdomen discomfort that necessitates rapid attendance at the emergency department, it occurs in approximately 17,700,000 individuals worldwide each year. Method. A case-control investigation was carried out on the patients with appendicitis in the operating room at Al-Sadr Hospital and Al-Shifaa Teaching Hospital in Basra, and the control group was randomly selected. Information was collected using a questionnaire. Results and Discussion. This study’s appendicitis patients were 56 males and 44 females. The age group ranging from 10 to 25 years was the most group affected by appendicitis (63%). The rate of non-smoking patients was 69%, higher than that of smoking patients (31%) and higher than smoking control (17%), with significance. The patients who live in the center have a high rate when compared with patients who live in the peripheral. The rate of patients who had a family history of appendicitis was (34%) lower than that of patients who had not a family history. Still, when compared with control with a family history (15%), their rate was higher with significance. Conclusion. The results of our study conclude that appendicitis affects young ages, but it can occur at any age, and a slight predominance can be observed in males compared to females, without significance. Smoking and a positive family history of appendicitis can be factors leading to appendicitis in an individual.
Keywords: AA acute appendicitis appendicitis Basra

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Introduction

Acute appendicitis (AA) is one of the most common clinical presentations of acute abdominal pain in adults and children in emergency departments [1]. A typical surgical emergency affects 17,700,000 people annually [2]. The lifetime risk is reported at 7%–8% [3]; acute appendicitis in children is more likely to be complicated than in adults [4], [5]. Appendicitis causes pain in the center of the abdomen that gradually spreads to the right lower quadrant. Another early symptom of appendicitis is a loss of appetite as a consequence of intestinal obstruction; nausea and vomiting can occur early in the course of the illness or even later [6], [7].

The diagnosis typically necessitates the integration of clinical, laboratory, and radiographic evidence, making it occasionally difficult [8]. Diagnosing AA can be difficult because to multiple possible diagnoses, particularly in females. Any delays in treatment might lead to higher rates of death and illness [4], [9]. Ultrasound and computed tomography (CT) have become the most often used methods for accurately diagnosing acute appendicitis. These modalities have also contributed to the widespread use of antibiotics in treating the condition. Patients without high-risk CT results should initially be managed with antibiotics, and surgery may be considered if antibiotic treatment proves ineffective [10]. It is routinely treated with surgical dissection of the appendix, an operation known as appendectomy [11], achieved by either an open or laparoscopic approach. While appendectomy for acute appendicitis is a standard surgical procedure, the pathophysiology and natural history of this condition remain unclear [12]. Potential factors that can initiate the processes of acute appendicitis include the blockage of the inner passage by an appendicolith (a calcified deposit), a tumor, an excessive growth of lymphoid tissue, an obstruction resulting from a foreign object, or a viral infection that subsequently leads to bacterial infection [5], [13].

The knowledge of the pathophysiology and causal mechanism of appendicitis is currently restricted [3], [14]. Current hypotheses have emphasized genetic variables, subtle environmental influences, allergies, and infections [3], [14], [15]. The etiology of AA is a subject of debate, with luminal obstruction, bacterial invasion leading to acute inflammation, initial infection, hereditary factors, and hypersensitivity type I reaction all potential contributing factors [14]. Regardless of the initial cause, it is believed that all of these factors contribute to an excessive proliferation of bacteria and the development of acute inflammation, which is responsible for the observed symptoms [16].

The aim of the study evaluate age and sex as factors influencing and relating to the effects of appendicitis, Comparison between appendicitis patients in the peripheral and central regions, and Evaluate smoking habits and positive family history of appendicitis as factors that cause an increase in incidence of appendicitis in an individual.

Materials and Method

Study Design/Subjects

A case-control study was conducted by collecting data using a questionnaire. Data was collected from the patients with appendicitis in the operating room at Al-Sadr Teaching Hospital and Al-Shifaa Teaching Hospital in Basra/Iraq from July 2023 to November 2023. The ages of control and patient samples in this study ranged from (12 to 63) years and were collected from 200 (100 patients and 100 controls). The Patient samples were (44 females and 56 males).

Data Collection

All patient and control information participating in the study was recorded in the questionnaire. Several demographic characteristics were considered for inclusion in this study, including Age, sex, smoking, Residency, and family history of appendicitis.

Statistical Analysis

In the present study, analysis was carried out using SPSS (Ver. 26). Student, Chi-Square test, and Fisher’s exact test were applied to compare all variables. Probability levels were less than 0.05 is significant (p < 0.05).

Results

Distribution of Patients with Appendicitis According to Sex

The results of the current study revealed that the incidence of appendicitis for males was 56.0% while it was 44.0% for females as in Table I, so statistically there were no significant differences (p = 0.5) between both sexes when p-value ≤ 0.05.

Category Total p-value*
Patient Control
Sex Male 56 52 108 0.570
56.0% 52.0% 54.0%
Female 44 48 92
44.0% 48.0% 46.0%
Total 100.0% 100.0% 100.0%
Table I. Distributions of Appendicitis According to Sex

Appendicitis Patients and Controls Distribution According to Sex and Age Groups

The present study of patients and the control group was divided according to sex and age into three groups, as shown in Table II. The results show no significant statistical associations among age groups and sex.

Age group (Year) Category Total p-value
Patient Control
10–25 Sex Male 33 23 56 0.568*
52.4% 46.9% 50.0%
Female 30 26 56
47.6% 53.1% 50.0%
Total 63 49 112
26–41 Sex Male 16 18 34 0.839*
57.1% 54.5% 55.7%
Female 12 15 27
42.9% 45.5% 44.3%
Total 28 33 61
>41 Sex Male 7 11 18 0.667**
77.8% 61.1% 66.7%
Female 2 7 9
22.2% 38.9% 33.3%
Total 9 18 27
Total Sex Male 56 52 108 0.565*
56.0% 52.0% 54.0%
Female 44 48 92
44.0% 48.0% 46.0%
Total 100 100 200
100.0% 100.0% 100.0%
Table II. Distribution of Groups According to Sex and Age Group (Year)

Comparison between Appendicitis Patients and Control with Smoking Habit

The results show that smoking patients have a lower rate (31%) than the patients with non-smoking habits (69%), as in (Table III). while the smoking patients have a high rate (31%) when compared with healthy control (17%) with a statistical difference (0.020).

Category Total p-value*
Patient Control
Smoking No 69 83 152 0.020
69.0% 83.0% 76.0%
Yes 31 17 48
31.0% 17.0% 24.0%
Total 100 100 200
Table III. Smoking State of Patients and Controls

Residence Distribution of Patients and Control Group

Table IV shows that the patients in the center region have a higher rate (56%) than the patients living in the peripheral (44%) with significant (p = 0.001).

Category Total p-value*
Patient Control
Residence Central 56 79 135 0.001
56.0% 79.0% 67.5%
Peripheral 44 21 65
44.0% 21.0% 32.5%
Total 100 100 200
Table IV. The Distribution of the Patients and Controls According to Residence State

Family History Status

Table V shows that patients without a family history of appendicitis had a rate of 34.6 per cent, while patients with appendicitis and positive family history had a rate of 34.4 per cent compared to 15.0 per cent in the control group, a statistically significant difference (0.002).

Category Total p-value*
Patient Control
Family historyof appendicitis No 66 85 151 0.002
66.0% 85.0% 75.5%
Yes 34 15 49
34.0% 15.0% 24.5%
Total 100 100 200
Table V. Comparison between Patients and Controls According to Family History of Appendicitis

Discussion

Acute appendicitis is a prevalent etiology of lower abdominal pain that prompts patients to seek immediate medical attention at the emergency department [8]. The level and progress of inflammation are directly related to how bad the infection is and how long the disease lasts. As this disease gets worse, extra fat around the appendix and organs around it start to be involved in the inflammation process [17].

100 people with appendicitis took part in a case-control study. Their ages ranged from 12 to 64 years. One hundred people were also watched as a control group. The study into this, the highest age group of patients with appendicitis was in the age group (10–25) years 63 (63%), followed by the age group (26–41) years 28 (28%). In contrast, fewer cases of appendicitis patients appeared in the age group more than (>41) 9 (9%) of total study cases 100 (100.0%). These results agree with those [18] from Azizyah/Iraq, which collected 400 cases; the majority ratio was (71.7%) in ages (10–29) [19] (Mathkoor, 2015) from AL-Basra\Iraq. Her study was done on 90 cases, and the majority ratio was (81.6%) in the age group (15–25); another study in AL-Najaf Iraq by [20] recorded that a higher ratio was (81%) observed in the age group with mean age (15–25) respectively from (110) patient as well as [21], [22], also with Other studies of [23]–[25], Founding that in general, acute appendicitis is most frequent between the age of 10 and 30 and in the age group of 20–30 years. Many studies have different findings, but one clear thing is that age trends vary from country to country. This is something that needs more research [26].

Petroianu and Barroso [27] suggested that the prevalence of appendicitis in young adults and teenagers supposes the pathophysiological role of lymphoid tissue in abundance in the appendix at this decade of life. In explanation of our results [28] concluded that the elevation in the incidence of appendicitis during the age (15–25) might be because appendicitis occurs due to obstruction of the appendix as a result of Lymphoid hyperplasia, The appendix has a lot of lymphoid tissue in the submucosa, and both the number and size of these cells grow with age, hitting their peak in adolescence, when the risk of getting appendicitis is highest, also [29] explained that the lower ratio was in age above 35 years that might be due to regression in the amount of lymphatic tissue in the appendix.

In the current study, the most cases of appendicitis were recorded among the male groups (56.0%) than (44.0%) for the female group of the total study patients 100 (100.0%). According to these results, according to a study by [30], acute appendicitis was more common in males. Most studies show a slight predominance in males compared to females [31], [32]. Also, agree with the study reported by [18], [19] as well as [20] from AL-Najaf Iraq they measured 110patient (62.7%) male and (37.3%) female, also [22], [33], [34] had male patients more than female, while our results disagree with [21] who had found higher appendicitis ratio in female (53%) than male (47%). Daldal and Dagmura [35] showed different results, which found (59.7%) of female and (40.3%) of male patients.

Distribution of appendicitis between both genders may be due to differences in sample size that are included in each research or the exclusion of some patient’s cases or may be due to misdiagnosis with other female diseases such as gynecologic diseases [20]. There are no significant statistical associations among age groups and sex.

The present study assessed the relationship between appendicitis and smoking habits; most cases of appendicitis recorded nonsmoking (69%) than smokers (31%) from total study cases, while the smoking patients had a high rate when compared with smoking control (17%) which reflects the significant effect of smoking among studied patients and control groups (p = 0.02). These results agree with [36] finding that the rate of smoking patients in his study was 29%. Another study shows that smoking increases the incidence of appendicitis, particularly among current smokers, regardless of the severity or length of their habit, and another research adds to the mounting evidence linking active tobacco use to the development of appendicitis.

Consequently, ongoing research is needed to explain better the pathogenesis, the environmental risk factors, and the epidemiological patterns of appendicitis [37]. Oldmeadow et al. suggested that smoking might disable an immune response associated with Ulcerative colitis (UC) and leave the appendix vulnerable to inflammation [37].

Another predisposing factor was a family history of appendicitis. the current study shows (34.0%) of cases are in the presence of appendicitis family history versus (66.0%) non-presence. Statistically, there were significant differences when compared with the patient and control groups (15.0%) (p = 0.002).

A study was done by [38] that examined the relationship between a positive family history and the diagnosis of appendicitis in adults. The study found that people who arrived at the emergency department (ED) with a known family history of appendicitis were more likely to have this illness compared to those without such a history. Upon discovering that patients with appendicitis (37.9%) had a higher occurrence of positive family history compared to those without appendicitis (23.7%), it was determined that positive family history was a significant independent predictor (p = 0.01) of appendicitis.

The hereditary predisposition to acute appendicitis may be attributed to environmental circumstances, including a particular bacterial infection and certain dietary habits, such as a low intake of fiber, which may have a crucial impact on the development of acute appendicitis. It is likely that a genetic variation in resistance to bacterial infection is responsible for around 70% of the cases [39]. Based on previous studies, it appears that knowing a patient’s family history of appendicitis, along with other clinical and laboratory findings, can help emergency physicians assess the likelihood of diagnosing appendicitis in patients who are suspected to have it at the Emergency Department [40].

The distribution of patients and control groups in this study were compared according to Residency, divided into central (56.0%) and peripheral (44.0%) patients. Significant statistical differences were found (p = 0.01). The results agree with [19] in Basra, Iraq, which found that (83.5%)cases from Urban areas and (16.5%) of cases from Rural areas [33] in America agrees with us with (88.8%) of urban & (11.2%) for rural areas, these differences in the incidence of appendicitis that presents in the Urban area were more than in Rural area may be because of the differences in the diet and the typical immune system [41], While the result of [42] in Al-Najaf/Iraq disagreed with our study who reported that the ratio in a rural area (61.72%) was higher than Urban area (38.2%) and that’s may be due to the differences in sample size period, and location of sample collection. This was in agreement with [43] Several reasons can explain this: The societal transformation, particularly post-2003, saw the proliferation of many fast-food establishments, the introduction of diverse culinary options, and a general escalation in pollution levels. Some experts propose that a shift in dietary patterns, characterized by the use of high-carbohydrate, low-fiber meals together with sweets or sugary beverages, may contribute to the development of appendicitis [44], [45]. The GBD 2019 study assessed many risk factors for appendicitis mortality, including inadequate fruit and vegetable diet, education level, and LDI [46].

Conclusion

The age group (10–25) year has the most significant percentage of appendicitis. Males were more commonly affected by appendicitis than females, and there was no significant statistical among age groups and sex. Smoking and a positive family history of appendicitis can be factors leading to appendicitis in an individual, with significant statistical among patients and control groups. Differences in Dietary habits and environmental and immunological may have made residents of the center have a higher rate of appendicitis than those who live in the periphery.

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