Deaths from acute appendicitis increase by 14% amid the pandemic.

By Carolina Kirchner Furquim and Fabiana Cambricoli, from Agência Einstein - Amid the Covid-19 pandemic, the number of Brazilians who died from acute appendicitis increased by 14,2% in 2020 compared to 2019, according to data from the Datasus portal of the Ministry of Health, tabulated by [source missing]. Einstein AgencyThere were 879 deaths in the first year of the pandemic compared to 770 the previous year. In the last decade, the average annual growth of deaths from this cause was 2%. The atypical increase in 2020 may be associated with delays in seeking medical help during the coronavirus outbreak and the overcrowding of hospitals during peak pandemic periods, which may have left patients with other health complaints without care.

“What we noticed was that there was a general delay in seeking medical help for a number of illnesses, aggravated by the fact that many emergency rooms were closed to become COVID-19 care centers. In other words, in addition to patients taking longer to seek help, they also took longer to access care, with hospitals overcrowded due to COVID,” argues Dr. Adonis Nasr, a digestive system surgeon, professor of surgery at the Pontifical Catholic University of Paraná (PUCPR) and coordinator of surgery at the Cajuru University Hospital in Curitiba (PR).

What is appendicitis?

The appendix is ​​an anatomical structure that represents an extension of the intestine. Because it is a lymphoid organ (which produces immune cells), it is believed that an immune stimulus can cause swelling and other events that characterize the disease, appendicitis.

According to Nasr, the initial symptoms of the disease are nonspecific, and the patient may experience vague abdominal pain, malaise, and loss of appetite. "Generally, nothing more than that," explains the specialist.

"Gradually, [the symptoms] intensify and generate more intense pain in the lower right quadrant "From the abdomen, leading to the most classic presentation of appendicitis. That is, we can expect pain in the right iliac fossa [one of the nine divisions of abdominal anatomy], associated with loss of appetite, nausea, vomiting, and low-grade fever. The tendency is for the condition to worsen, with local deterioration and a decline in the patient's overall condition, who becomes more febrile and more tachycardic [increased heart rate]," the surgeon explains.

Before the pandemic

Until the onset of COVID-19, the vast majority of appendicitis cases, according to the surgeon, were resolved in the early stages, with the infection localized in the appendix, through a relatively simple surgery, with hospital discharge within 24 hours. "With the arrival of the pandemic, we started seeing increasingly severe cases, already progressing to peritonitis, when there was complete obstruction of the appendix and its perforation," he states. 

The specialist explains that the obstruction process is progressive and, when it happens, the resolution is much more complicated. “Appendicitis treated in time, before perforation, is done with surgical removal of the appendix, which requires a small incision. When the patient arrives with a picture of systemic progression, eventually…” We need to make a large incision in the middle of the abdomen to clean the entire cavity. Often, more than one surgery is necessary for this cleansing, which results in a much higher mortality rate in these cases.”

warning signs

Since the initial symptoms of appendicitis are also common to other diseases, the patient needs to be alert to their persistence. If there is no improvement and the pain becomes increasingly intense and localized, this is the main warning sign. 

"Patients with this presentation account for half of the cases. The other half have atypical symptoms that can lead to a later diagnosis, such as minor discomfort or even diarrhea masking peritonitis, for example," concludes the doctor.

Incidence

Appendicitis is the most common surgical emergency in hospital emergency departments worldwide. Traditionally, the age group most commonly affected is up to 30 years old, with a peak between six and 20 years. The incidence decreases over time, but it can occur in people of any age. 

Check out the comparison of deaths from the disease in Brazil between 2011 and 2020:

Deaths from acute appendicitis

YEAR	NUMBER OF DEATHS
2011	661
2012	715
2013	740
2014	760
2015	739
2016	735
2017	755
2018	785
2019	770
2020	879

Source: Mortality Information System (SIM)/Datasus/Ministry of Health

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