Auditing Appendectomy in Benue State University Teaching Hospital, Makurdi, Nigeria

Auditing Appendectomy in Benue State University Teaching Hospital, Makurdi, Nigeria

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Barnabas Eke
Babarinde Ojo
Bamidele Omolobake
Umobong Emanso
Issac Akpor
Raymond Vhriterhire
Victor Ugwu
Michael Enokela Efu
Gyenger David
Confort Udu


Appendicitis is the leading cause of surgical admission in most hospitals in Nigeria and the removed appendix, a frequent surgical specimen in most routine histopathological laboratories in Nigeria. The aim of this study is to audit the appendectomy procedures in Benue State University Teaching Hospital. Sixty-two appendices removed for acute appendix in Benue State University Teaching Hospital, Makurdi, Nigeria middle belt, over an 8-year period were analyzed. Twenty-eight (45%) were found to be normal, while 29 (46%) showed histopathological evidence of acute inflammation. There were 5 (9%) cases of unusual pathologies which include a case each of metastatic adenocarcinoma and chronic granulomatous inflammation (2% each) and 3 (5%) cases of schistosomiasis. The Negative Appendectomy Rate (NAR) was 27% in females compared with 18% in males. Adult (>16 years) represented 29% of the NAR. The overall NAR was 45%. The NAR in this study is considerable higher when compared with existing literature. In a poor resource center like Benue State University Teaching Hospital, due diligence in taking detailed history coupled with good clinical examination cannot be over emphasized. The use of a combination of Total Leukocyte Count (TCC) and C-Reactive Protein (CPR) in every patient may help in reducing NAR, though it’s definitely going to be impossible to eradicate it.


Addiss DG, Shaffer N, Fowler BS, Tauxe RV. The epidemiology of appendicitis and appendectomy in the United States. Am J Epidemiol. 1990; 132(5): 910-25.

Alatise OI, Ogunweide T. Acute appendicitis: Incidence and management in Nigeria. IFEMED J. 2008; 14(1): 66-70.

Ashindoitiang JA. Clinical presentation of appendicitis in Nigeria adults. J Med Med Sci. 2011; 2(10): 1147-1151.

Bijnen CL, Van den Broek WT, Bijnen AB, De Ruiter P, Gouma DJ. Implications of removing a normal appendix. Dig Surg. 2003;20(2): 115-121.

Chamisa IA. A clinicopathological review of 324 appendices removed for acute appendicitis in Durban, South Africa: A retrospective analysis. Ann R Coll Surg Engl. 2009; 91: 688-692.

Coursey CA, Nelson RC, Patel MB, Cochran C, Dodd LG, Delong DM, Beam CA, Vaslef S. Making the diagnosis of acute appendicitis: do more preoperative CT scans means fewer negative appendectomies? A 10 year study. Radiology. 2010; 254(2): 460-468.

Flum DR, Koepsell T. The Clinical and economic correlates of misdiagnosed appendicitis; nationwide analysis. Arch Surg. 2002; 137(7):799-804.

Gronroos JM. Clinical suspicious of acute appendicitis- is the time ripe for more conservative treatment? Minim Invasive Ther Allied Technol. 2011; 20(1):42-45.

Hale DA, Molloy M, Pearl RH, Schutt DC, Jacques DP. Appendectomy: a contemporary appraisal. Ann Surg. 1997; 225(3): 252-61.

Howell JM, Eddy OL, Lukens TW, Thiessen ME, Weingart SD, Decker WW. Clinical policy: critical issues in the evaluation and management of emergency patients with suspected appendicitis. Ann Emerg Med. 2010; 55: 71-116.

Joshi MK, Joshi R, Alam SE, Agarwal S, Kumar S. Negative appendectomy: an audit of resident–performed surgery. How can its incidence be minimized? Indian J. Surg. 2015; 77 (Suppl 3): S913-S917.

Kumar V, Abbas AK, Aster JC. Acute Appendicitis. In: Robbins and Cotran Pathologic Basis of Disease. 9th ed. Philadelphia: Saunders; 2015.

Lameris W, van Randen A, Go PM, Bouma WH, Donkervoort SC, Bossuyt PM, Stoker J, Boerneester MA. Single and combined diagnostic value of clinical features and laboratory tests in acute appendicitis. Acad Emerg Med. 2009;16(9): 835-842.

Ma KW, Chia NH, Yeung HW, Cheung MT. If not appendicitis, then what else can it be? A retrospective review of 1492 appendectomies. Hong Kong Med J. 2010; 16(1):12-17.

Madiba TE, Haffejee AA, Mbete DL, Chaithran H, John J. Appendicitis among African patients at King Edward VIII Hospital, Durban, South African: a review: East Afr Med J. 1998; 75 (2): 81-4.

Mangete EDO, Kombo BB. Acute appendicitis in Port Harcourt, Nigeria. Orient J Med. 2004; 16 (1) 1-3.

Mariadason JG, Wang WN, Wallack MK, Belmonte A, Matari H. Negative appendectomy rate as a quality metric in the management of appendicitis: impact of computed tomography, Alvarado score and the definition of negative appendectomy. Ann R Coll Surg Engl. 2012; 94(6): 395-401.

Marudanayagam R, Williams GT, Rees BI. Review of the pathological results of 2660 appendectomy specimens. J Gastroenterol. 2006; 41(8): 745-9.

Merlin MA, Shah CN, Shiroff AM. Evidence based appendicitis: the initial work-up. Postgrad Med. 2010;122(3):189-195.

Muthupei MN, Morwanoche P. The surgical pathology of the appendix in South African blacks. Cent Afr J Med. 1998; 44 (1): 9-11.

National Health Service. Hospital episode statistics. Admitted Patient care, England. 2012-2013. Procedures and interventions. Available at: 12566/hwp-epis-stat-admi-proc-2012-13-tab.xIsx.

Ojo OS, Udeh SC, Odesanmi WO. Review of the histopathological findings in appendices removed for acute appendicitis in Nigerians. J R Coll Surg Edinb. 1991; 36 (4): 245-8

Omiyale AO, Adjepong S. Histopathological correlations of appendectomies: a clinical audit of a single center. Ann Transl Med. 2015; 3(9): 119-23.

Raja AS, Wright C, Sodickson AD, Zane RD, Schiff GD, Hanson R, Baeyens PF, Khorasani R. Negative appendectomy rate in the era of CT: an 18-year perspective. Radiology 2010;256(2): 460-465.

Rosen MP, Ding A, Blake MA, Baker ME, Cash BD, Fidler JL, Grant TH, Greene FL, Jones B, Katz DS, Lalani T, Miller FH, Small WC, Spottswood S, Sudakoff GS, Tulchinsky M, Warshauer DM, Yee J, Coley BD. ACR Appropriateness Criteria right lower quadrant pain—suspected appendicitis. J Am Coll Radiol. 2011; 8(11): 749-755.

Swank HA, Eshuis EJ, Ubbink DT, Bemelman WA. Is routine histopathological examination of appendectomy specimens useful? A systematic review of literature. Colorectal Dis. 2011; 13(11): 1214-21.

Webb EM, Nguyen A, Wang ZJ, Stengel JW, Westphalen AC, Coakley FV. The negative appendectomy rate: who benefits from preoperative CT? AJR Am J Roentgenol. 2011; 197(4):861-6.

Zoarets I, Poluksht N, Halevy A. Does selective use of computed tomography scan reduce the rate of “white” negative appendectomy? Isr Med Assoc J. 2014; 16(6):335-7.