Acute appendicitis in pregnancy: case series and review

Abstract

OBJECTIVE:Acute appendicitis is one of the most common acute surgical pathology we encountered. In this study we investigated our pregnant cases of appendicitis, and reviewed literature.METHODS:A total of 21 pregnant women who underwent appendectomy with the initial diagnosis of acute appendicitis in Istanbul Medeniyet University Clinics of General Surgery between January 2012, and December 2014 were retrospectively analyzed. The patients’s ages, trimesters, complaints, abdominal examination, laboratory, and ultrasonographic findings, surgical techniques, complications and hospital stay were noted.RESULTS:The patients were in their first (n=12; 57.1%), second (n=5; 23.8%), and third trimesters (n=4; 19.0%) of their pregnancies Median age was 23.9 years. All of the patients had abdominal pain. Median value of WBC count was 13.297/mm³. Ultrasound was positive in 12 patients (57.1%). In 14 (66.6%) patients McBurney incision, and in 6 (28.6%) cases right paramedian incision were used. One patient (4.8%) underwent laparoscopic appendectomy. Nineteen cases were acute appendicitis (90.5%), and two cases were perforated appendicitis (9.5%). Average hospital stay was 3.8 days. Two cases with perforated acute appendicitis developed wound infection and treated conservatively. There were no fetomaternal mortality.CONCLUSION:Physiologically anatomic and biochemical changes occurring during pregnancy can delay the diagnosis of acute appendicitis threaten the lives of both the mother and the fetus Therefore, rapid diagnosis and appropriate treatment convey importance.

Acute appendicitis in pregnancy: 50 case series, maternal and neonatal outcomes

“…[17] Perinatal mortality was 1.5% in uncomplicated appendicitis and 37% in perforated appendicitis. [18] Perinatal mortality rate was 4%, and the perforated appendicitis rate was 14% in our study. One of these patients had multiple fetal anomaly.…”

Can Patients with Appendicitis in Pregnancy be Operated in Secondary Hospital: A retrospective Study

“…Fetal mortality is 1.5% in uncomplicated appendicitis, in perforated appendicitis the rate increases up to 37% (11). The fetal mortality rate in our study was 3.4%.…”

Analysis of 190 Female Patients after Appendectomy

“…The clinical and radiological evaluation of AA during pregnancy is challenging [ 22 ]. In a review of 21 pregnant, abdominal pain was higher in the first and second trimester by 57% and 23%, respectively [ 23 ]. Vomiting was the most common symptom noted in other series [ 9 , 24 ].…”

“…Approximately 80% of pregnant women undergo procedures in an emergency setting, with 38.4% undergoing OA vs. 63.6% LA [ 16 ]. Others reported a high rate of OA in pregnant women, which reached 73% and 92% [ 8 , 19 , 23 ]. From the New York State database which included 1000 patients, OA was performed in community centers by 50% and LA in academic centers by 60% [ 21 ].…”

“…Conversion to open depends mainly on intraoperative findings rather than surgeon experience [ 24 ]. The incision in OA differed in the literature with 66–93% McBurney's point, 28.6% right paramedian, and 6.6% midline laparotomy [ 10 , 11 , 23 , 33 ].…”