Risk Factors for Intra-Abdominal Abscess Formation After Appendectomy: A Multicenter Study from Africa

Background Postoperative intra-abdominal abscess (IAA) remains a significant cause of morbidity after appendectomy, particularly in low-resource settings where delayed presentation and advanced disease are common. This study aimed to identify factors associated with postoperative IAA formation after appendectomy in an African setting and to evaluate management strategies and outcomes. Methods A multicenter retrospective cohort study was conducted at three tertiary hospitals in Mogadishu, Somalia. All patients who underwent appendectomy between January 2024 and July 2025 were included. Demographic, clinical, intraoperative, and postoperative variables were collected from medical records. The primary outcome was the development of an intra-abdominal abscess within 30 days after appendectomy. Patients with and without IAAs were compared. Results Ninety-two patients were included, of whom 19 (20.7%) developed postoperative IAAs. Delayed presentation beyond 48 hours was significantly more frequent in the abscess group (94.7% vs. 30.1%, p < 0.001). Perforated appendicitis and appendicolith presence were strongly associated with IAA formation. Operative times longer than 60 minutes and drain placement were also more common among patients with IAAs. These patients experienced longer hospital stays and higher rates of wound infection and sepsis. Most abscesses were successfully managed with antibiotics alone. Conclusion Postoperative IAA formation after appendectomy in this low-resource setting is primarily driven by delayed presentation and advanced disease severity. Improving early access to surgical care and optimizing perioperative management may reduce postoperative morbidity.