Acute appendicitis complicating pregnancy: a 33 case series, diagnosis and management features, maternal and neonatal outcomes

Abstract

The occurrence of acute appendicitis during pregnancy may pose diagnostic and therapeutic difficulties. In fact pregnancy can make the clinical diagnosis delicate and the use of morphological examinations is still subject to controversy. The debates concerning the ideal surgical approach during pregnancy continue. On the other hand, in some cases the occurrence of acute appendicitis, especially in its complicated form, which is frequent in pregnant women, exposes to obstetrical complications and an increased risk of premature delivery We aims to describe the clinical and management features of acute appendicitis in pregnant women and the maternal and neonatal outcomes and carry out a review of the literature on this topic. It is a retrospective analysis of a series of 33 cases of appendicitis in pregnant women who were diagnosed and managed, in collaboration between the departments of General and digestive surgery, Gynecology and Obstetrics and Anaesthesia at Farhat Hached Universitary Hospital Sousse Tunisia between January 2005 and December 2015. The average age of the patients was 29 (20-40). Fourteen patients were in the first trimester, twelve in the 2nd and seven in the third trimester. The main symptom was pain in the right iliac fossa. The mean delay between consultation and surgery was 2.7 days. Twenty five patients had a preoperative ultrasound. Eight of the 33 pregnant patients presented complicated appendicitis with localized or generalized peritonitis. Thirty patients underwent laparotomic appendectomy: 28 with a Mc Burney incision and 2 with a midline incision and only three patients underwent laparoscopy. Preventive tocolysis was given to 14 patients, maternal mortality was null. Twenty four pregnancies were followed until delivery: one case of premature birth and one case of preterm labor were observed. Pregnancy makes it difficult to diagnose appendicitis, which explains the high rate of complicated acute appendicitis in our series. An early treatment improves maternal and fetal outcome.

Non-obstetric surgery during pregnancy – an eleven-year retrospective analysis

“…In accordance with published studies, in our patient collective, acute appendicitis was the predominant reason for nonobstetric abdominal surgery during pregnancy [6,14]. Complicated forms of acute appendicitis are reported to be more frequent in pregnant women and are associated with obstetrical complications such as premature delivery [4][5][6]. In our total collective, there were 12 premature births (16%), of which only 4 (10%) occurred after open appendectomy (none of which was characterized as complicated).…”

“…The most frequent indications for surgery during pregnancy are infections such as acute appendicitis and cholecystitis [5][6][7][8][9][10][11][12][13][14]; pregnant women may also require acute surgical intervention for ovarian disorders and bowel obstruction, as well as for traumatological or oncological indications [11]. Any kind of pathology can occur in pregnant women and require immediate surgical treatment and optimized interdisciplinary management to achieve maximum safety for both mother and fetus, to avoid teratogenous medication, fetal acidosis and hypoxemia, and adverse pregnancy outcomes such as miscarriage, stillbirth or premature birth [4,8].…”

Acute Appendicitis in Pregnancy: How to Manage?

“…Studies argue that it is seen the most frequently in the different trimesters. [ 2 , 4 , 7 ] In the present study, 76.2% of the cases were operated in the second trimester, but it is not true to generalize the dominancy of one of the three trimesters. [ 4 ]…”

“…Perforation and other forms of complicated acute appendicitis are more frequently seen in pregnant women than those in the normal population. [ 6 , 7 ] While the fetal loss rate is 1.5% in uncomplicated patients, this may rise up to 36% in cases with perforation. [ 1 , 8 ] Therefore, early diagnosis and treatment are quite important in terms of avoiding both maternal and fetal morbidity and mortality.…”

Adolesan bir gebede akut batın tablosu olarak perfore apandisit olgusu

“…Akut apandisit, gebe kadınlarda obstetrik olmayan cerrahi aciller (akut apandisit, safra yolları hastalıkları, üriner sistem obstrüksiyon ve enfeksiyonları, barsak obstrüksiyonları, herniler, inflamatuar barsak hastalıkları, perfore ülserler, intraabdominal kanama ve tümörler) arasında en sık karşılaşılan akut batın tablosudur [6]. Akut apandisitte batın sağ alt kadran ağrısı en sık görülen semptomdur; ancak gebelikte uterusun genişleyip büyümesine bağlı olarak apandiks kraniyal yönde yer değiştirir ve sağ üst kadran, sırt veya yan ağrısı şeklinde prezentasyonlar görülebilir [8]. Bulantı, kusma ve iştahsızlık akut apandisit semptomları arasında bulunan diğer şikâyetlerdir.…”