Gallstone disease among black South Africans. A review of the Baragwanath Hospital experience.

It has been suggested that gallstone disease is rare in Africa. The 118 cholecystectomies for this condition performed at Baragwanath Hospital over the 3-year period 1983-1985 were reviewed; 100 records were available. The male: female ratio was 1:4, the mean age 51 years. Fifty-one per cent of patients presented with acute cholecystitis, 18% with obstructive jaundice, 9% with pancreatitis and only 22% with biliary colic. The incidence of complicated presentation was higher in the over 60-year-old age group (P less than 0.05). The correct diagnosis was made on admission in only 41% of cases. The mean delay in diagnosis was 5 days; however, the delay was 8 days for patients admitted to the medical wards compared with 2 days in the surgical wards (P less than 0.001). Elective operations were performed on 82% of patients and 18% had urgent surgery. The incidence of common bile duct stones was 22%. The overall mortality rate was 10%; however, the mortality rate was 3.2% for the under-60-year-old group compared with 21% for patients 60 years and older (P = 0.006). This series, which is probably the largest reported in black patients, suggests that greater awareness of acute cholecystitis is necessary in the black patient since there is a rising in-hospital incidence.