Seasonal and day of week variations in acute appendicitis in north Indian children.

Sir,

Acute appendicitis is the most common cause of acute abdomen requiring surgical intervention during childhood; accounting for 1-8% of children who present to the pediatric emergency room with acute abdominal pain.[1] We conducted a retrospective record based study over a decade (from January 2003-July 2012). All the histologically diagnosed cases of pediatric acute appendicitis were included in the study. A total of 395 cases were included. Total cases admitted during the study period were also recorded.

There were 316 males while 79 were females. M: F ratio was 4:1 [Table 1]. Forty one children (10.37%) were ≤5 years of age; while 354 (89.6%) were above the age of 5 years.

Table 1

Age and sex wise distribution of appendicitis cases

A continuous increase in appendicitis cases was noticed over the years. When we studied the month-wise distribution of cases then the cases were maximum in the month of August and minimum cases were noticed in January [Figure 1].

Figure 1

Month-wise distribution of appendicitis cases

When analyzed as per the day of presentation of appendicitis, then it was Fridays that were found for increased likelihood as the day of presentation more than any other day of the week [Figure 2].

Figure 2

Presentation of appendicitis cases as per the day of week

The steady increase in the number of cases corresponds with the onset of the rainy season. In this study the maximum cases were noticed in July to September quarter, in India this represents the rainy season with highest humidity in the environment. This finding of seasonal variations is also confirmed by Gallerani et al, in their study.[2] The presence of seasonal variation shows the possibility of heterogenous extrinsic factors such as, humidity, allergens, sun radiation, and viral and bacterial infections in the etiogenesis of appendicitis. Khaevel et al, also postulated the importance of the actual reduction of sun radiation and vast fluctuations in air temperature, in the incidence of appendicitis.[3] Increase in the incidence of bacterial and viral infections (causing lymphoid hyperplasia leading to appendix lumen obstruction) and parasitic infestations during this period could also contribute to the higher incidence of appendicitis, in a region where the climate is characterized by high humidity and heavy rainfall, in an environment with poor sanitation. Appendicitis is more common during the rainy season, a period known for humidity, high incidence of bacterial and viral infections, and high prevalence of intestinal parasites, so awareness about this disease should be generated to take care of the children particularly in the rainy season.