Outcome of Tube Caecostomy: A Justifiable Alternative in the Surgical Treatment of Advanced Appendicitis

Background: Advanced appendicitis is a problem in Africa, and it is a reflection of delayed presentation. Its incidence is about 40-50% of all cases and this disease is unfortunately associated with a high mortality of about 0.9 to 4%, certainly higher than in the developed world. Advanced appendicitis poses a serious challenge to surgeons in poor resource settings and it is associated with a higher morbidity and mortality.

Objective: To report the outcome of tube-caecostomy in the prevention of fistula formation after appendicectomy for appendicular mass, abscess or gangrenous appendix.

Methods: A retrospective study involving all patients diagnosed with appendix mass, abscess and gangrenous appendix admitted into Central Hospital Benin City from October 2005 to October 2010. Data was collated from patient’s case notes, theatre records and ward registers. The Stamm procedure using a size 24 three-way catheter as a caecostomy tube was used. The data collected was analyzed as age, mean age, peak age incidence, sex ratio and percentages.

Results: A total of 14 patients underwent tube caecostomy during appendicectomy. There were 10(71.4%) males and 6(28.6%) females. The male-to-female ratio was 2.5:1. The ages of the patients ranged from 14-42 years with a mean age of 28.5 years. Seven (50%) of the cases had wound infection, and three (21%) had wound dehiscence. Hospital stay ranged from 14 to 33 days with a mean stay of 19.1 days. No serious catheter-related complications nor residual abscesses were recorded and there were no mortalities in this study.

Conclusion: Tube caecostomy as a procedure performed for advanced appendicitis is a favourable alternative to interval appendicectomy, right hemicolectomy and ileostomy. The latter two procedures require an experienced surgeon and are fraught with high morbidity and mortality. Future research should be directed towards carrying out a prospective study comparing the efficacy of tube-caecostomy with interval appendicectomy.