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

Abstract

Background: 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 the ward registers. The Stamm procedure using a size 24 three-way catheter as caecostomy tube was used. 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 14-42years with mean age of 28.5 years. Seven (50%) of the cases had wound infection, three (21%) had wound dehiscence. Hospital stay ranged from 14 to33days with a mean stay of 19.1 days. No serious catheter related complications nor residual abscess 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 a high morbidity and mortality.