The Effect of Environmental Factors on the Incidence of Complicated Appendicitis in Mongolian Paediatric Population

Abstract

Introduction: Acute appendicitis (AA) in children is the primary cause of urgent surgery in pediatric patients. Diagnosis of AA continues to be a challenge, especially in the youngest children, who often present with abdominal pain accompanied by nonspecific signs. As epidemiological data on the relationship between acute appendicitis and environmental factors are relatively few and the issue is still controversial, we conducted this study which compared two groups of patients with complicated and noncomplicated appendicitis in a sample of patients admitted to a MNCMCH. The aim of this study was to determine the risk factors for complications in acute appendicitis in the paediatric population. Methods: Our study was performed on 1003 children admitted for suspected acute appendicitis and underwent appendectomy at the MNCMCH, Ulaanbaatar Mongolia, between January 2019 and December 2019. The diagnosis was based on the results of pathological examination. The two groups of complicated (gangrenous and perforated) and noncomplicated (catarrhal and phlegmonous) acute appendicitis were compared. Results: 1003 pediatric patients (≤18 years old) were suspected of having acute appendicitis and subsequently underwent surgery. From a total of 967 patients, 56% (n = 542) were male, 44% (n = 425) were female (gender ratio was 1.3:1). The histological examination noted that 33.1% were uncomplicated, 66.9% were complicated. While the incidence of acute appendicitis was higher during winter, the highest incidence of complicated appendicitis was observed equally in winter and autumn without significant association (p = 0.541). The months of December and March were marked by the highest incidence of AA. The highest incidence of complicated appendicitis was observed during the month of December (45%) with statistically significant difference (p < 0.001). Our study of the incidence of family history, allergy and family members was noted in complicated and noncomplicated group with statistically significant difference (p < 0.001). Conclusions: Pediatric acute appendicitis incidence is increased in winter months in Mongolia. Preventive measures to decrease morbidity and mortality associated with this disease can be taken during the winter seasons from December to March. However, further large-scale studies are needed to support this conclusion.