Incidence and histological outcomes of appendectomies in a South African regional hospital, 2022 - 2023: A retrospective study
DOI:
https://doi.org/10.7196/SAMJ.2026.v116i2.3689Keywords:
Appendicitis, appendectomy, General surgeryAbstract
Background. Acute appendicitis is one of the most common surgical emergencies in South Africa (SA), yet local histopathological data on appendectomies remain limited.
Objective. To determine the incidence and histological patterns of appendicitis at an SA regional hospital over a 2-year period.
Methods. A retrospective review was conducted on all appendectomies performed at Tambo Memorial Hospital (TMH) in Boksburg, SA, from 1 January 2022 to 31 December 2023. Histological data, using Gomes score, which was correlated with microscopy and macroscopy from the SA National Health Laboratory Service, as well as patient demographics, were analysed. Logistic regression and χ2 tests were used to assess associations between variables.
Results. A total of 283 appendectomies were reviewed. None was excluded. The cohort was predominantly male (64%), with a mean age of 26.99 years. Histologically normal appendices (grade 0) were found in 25.4% of cases. Grade 4 appendicitis (gangrenous/perforated) was the most prevalent pathological finding (39.9%). Males were significantly more likely to present with appendicitis, particularly advanced grades of appendicitis (p=0.00005; odds ratio (OR) 3.305, 95% confidence interval (CI) 1.869 - 5.915). Lymphoid hyperplasia was significantly associated with grade 0 appendices (p=0.00205; OR 0.282, 95% CI 0.125 - 0.631), suggesting possible alternative diagnoses such as gastroenteritis, mesenteric adenitis or pelvic inflammatory disease. Appendicular neoplasms (2.1%), faecoliths (17.3%) and parasites (1.4%) were not uncommon. No significant monthly variation was observed. The overall negative predictive value of clinician-directed appendectomy at TMH was 25.4%, in keeping with or better than rates reported at various tertiary hospitals – despite TMH lacking afternoon sonography and having no after-hours sonographic or radiological reporting services.
Conclusion. Appendicitis at TMH showed a high rate of complicated cases, especially among males. Male sex was a significant predictor of appendicitis, whereas lymphoid hyperplasia was associated with negative histology and may represent an important clinical differential diagnosis. Other findings included benign neoplasms, faecoliths and parasites. These findings highlight clinical acumen in a resource- limited setting and the value of histological confirmation in appendicitis diagnoses.
References
1. Yang E, Kahn D, Cook C. Acute appendicitis in South Africa: A systematic review. S Afr J Surg
2015;53(3 and 4):31-38.
2. Guan L, Liu Z, Pan G, et al. The global, regional, and national burden of appendicitis in 204 countries
and territories, 1990 - 2019: A systematic analysis from the Global Burden of Disease Study 2019. BMC
Gastroenterol 2023;23(1):44. https://doi.org/10.1186/s12876-023-02678-7
3. Berry J Jr, Malt RA. Appendicitis near its centenary. Ann Surg 1984;200(5):567-575. https://doi.
org/10.1097/00000658-198411000-00002
4. Withers A, Loveland J. Demographics of paediatric patients presenting with acute appendicitis:
A 5-year retrospective review of hospitals served by the Department of Paediatric Surgery at the
University of the Witwatersrand. S Afr J Child Health 2019;13(2):69-72. https://doi.org/10.7196/
sajch.2019.v13i2.1557
5. Bhangu A, Søreide K, Di Saverio S, Assarsson JH, Drake FT. Acute appendicitis: Modern understanding
of pathogenesis, diagnosis, and management. Lancet 2015;386(10000):1278-1287. https://doi.
org/10.1016/s0140-6736(15)00275-5
6. Ucar Karabulut K, Erinanc H, Yonar A, Kisinma A, Ucar Y. Correlation of histological diagnosis and
laboratory findings in distinguishing acute appendicitis and lymphoid hyperplasia. Ann Surg Treat Res
2022;103(5):306-311. https://doi.org/10.4174/astr.2022.103.5.306
7. Lesi O, Walton SJ, Ballanamada Appaiah NN, et al. Prevalence of carcinoma in appendectomy
specimens for patients presenting with acute appendicitis: A single-center study. Cureus
2021;13(11):e19611. https://doi.org/10.7759/cureus.19611
8. Nshuti R, Kruger D, Luvhengo TE. Clinical presentation of acute appendicitis in adults at the Chris
Hani Baragwanath Academic Hospital. Int J Emerg Med 2014;7(1):12. https://doi.org/10.1186/1865-
1380-7-12
9. Mason JH, Byrne MP, Gaw FC. Surgery of the vermiform appendix. Surg Clin North Am
1977;57(6):1303-1315. https://doi.org/10.1016/s0039-6109(16)41389-7
10. Chamisa I. A clinicopathological review of 324 appendices removed for acute appendicitis in
Durban, South Africa: A retrospective analysis. Ann Royal Coll Surg 2009;91(8):688-692. https://doi.
org/10.1308/003588409x12486167521677
11. Jolayemi OO, Moodley NB, Kong VY, Tlou B, Bruce JL, Clarke DL. The usefulness of routine
histological examination of appendicectomy specimens in a South African tertiary centre. S Afr Med J
2018;108(4):342-346. https://doi.org/10.7196/SAMJ.2017.v108i4.12759
12. Singh JP, Mariadason JG. Role of the faecolith in modern-day appendicitis. Ann Royal Coll Surg
2013;95(1):48-51. https://doi.org/10.1308/003588413x13511609954851
13. Jonas L, Bombil I, Mannell A. Unusual histopathologies of the appendix. S Afr J Surg 2020;58(3):160.
https://pubmed.ncbi.nlm.nih.gov/33231010/ (accessed 11 February 2026).
14. Akbulut S, Tas M, Sogutcu N, et al. Unusual histopathological findings in appendectomy specimens:
A retrospective analysis and literature review. World J Gastroenterol 2011;17(15):1961-1970. https://
doi.org/10.3748/wjg.v17.i15.1961
15. Torgerson PR, Devleesschauwer B, Praet N, et al. World Health Organization estimates of the global
and regional disease burden of 11 foodborne parasitic diseases, 2010: A data synthesis. PLoS Med
2015;12(12):e1001920. https://doi.org/10.1371/journal.pmed.1001920
16. Chang AR. An analysis of the pathology of 3003 appendices. Aust N Z J Surg 1981;51(2):169-178.
Downloads
Published
Issue
Section
License
Copyright (c) 2026 A H Shulman, L Broderick, J Nel, G Shemesh, N N Tshabalala , M G Mendelow, M J Malapane, Y E Segal, S Raichund, Z F A Peermamode, L Nsakala, A Singh
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Licensing Information
The SAMJ is published under an Attribution-Non Commercial International Creative Commons Attribution (CC-BY-NC 4.0) License. Under this license, authors agree to make articles available to users, without permission or fees, for any lawful, non-commercial purpose. Users may read, copy, or re-use published content as long as the author and original place of publication are properly cited.
Exceptions to this license model is allowed for UKRI and research funded by organisations requiring that research be published open-access without embargo, under a CC-BY licence. As per the journals archiving policy, authors are permitted to self-archive the author-accepted manuscript (AAM) in a repository.
Publishing Rights
Authors grant the Publisher the exclusive right to publish, display, reproduce and/or distribute the Work in print and electronic format and in any medium known or hereafter developed, including for commercial use. The Author also agrees that the Publisher may retain in print or electronic format more than one copy of the Work for the purpose of preservation, security and back-up.
