Review of Operative vs. Non-Operative Management of Appendicitis in Pregnancy

Abstract

The last decade has marked a paradigm shift in the care for acute appendicitis in children and non-pregnant adults. Although surgical management remains the safest treatment modality for perforated or complicated appendicitis, antibiotic therapy has been proven to be safe in adult and pediatric patients with non-perforated appendicitis. However, controversy exists for the type of surgery (laparoscopic vs. open) and the post-operative antibiotic regimens which result in optimal patient care of pregnant as well as non-pregnant adults. As several authors have begun to evaluate a non-operative strategy for treating acute appendicitis, whether with antibiotic therapy alone or combined with image-guided percutaneous drainage, others have retrospectively analyzed these strategies to pregnant women with abdominal pain. This collective review presents the epidemiology and diagnostic challenges of acute appendicitis in the pregnant patient and a review of the data that supports non-operative management in non-pregnant adults and pediatric patients as well as the limited data that supports non-operative management in pregnant adults.

Concurrent ruptured spontaneous heterotopic pregnancy and ruptured appendix with delayed presentation in the first trimester: a case report

“…The predictive Alvarado score may be unreliable in pregnancy owing to physiological changes in leucocytes and clinical parameters [ 18 - 20 ]. USS is an important imaging modality; however, in pregnancy appendicitis may be missed due to shift in position [ 2 , 6 , 20 ]. In a retrospective case analysis of 31 patients who underwent appendicectomy by Lin et al .…”

“…The choice of interventions includes medical treatment with antibiotics and operative surgery, either laparotomy or laparoscopic appendicectomy [ 20 ]. Most surgeons opt for surgical intervention; the choice between laparotomy and laparoscopy is guided by resource availability and surgical skills.…”

Acute Appendicitis in Pregnancy-Current Management-Review Article

“…The risk of fetal loss increases with a delay in the diagnosis and the presence of complications like abscess formation or generalized peritonitis. Laparoscopic appendectomy is emerging as a procedure that can be performed successfully in pregnant patients with acute appendicitis but the long-term data on its safety and efficacy are still limited [23,24].…”

Apendicitis en el embarazo

“…El tratamiento definitivo para la apendicitis aguda es la apendicectomía, ya sea abierta o laparoscópica, asociado a la administración de antibióticos profilácticos de amplio espectro. Esta patología debe ser abordada de forma oportuna, ya que el retraso en su manejo se asocia con resultados adversos tanto maternos como fetales e539 Revista Médica Sinergia Vol.5 (7), Julio 2020 -ISSN:2215-4523 / e-ISSN: http://revistamedicasinergia.com diagnosis is based on clinical and laboratory values, pregnant patients may not present the classic findings of acute appendicitis, so imaging studies are essential in case of diagnostic doubt. The definitive treatment for acute appendicitis is appendectomy, either open or laparoscopic, associated with the administration of broad-spectrum prophylactic antibiotics.…”

“…Hoy en día, la apendicitis aguda se define como la inflamación del apéndice vermiforme y se reconoce como la emergencia quirúrgica no obstétrica más común durante el embarazo (1)(2)(3)(4)(5)(6). Seguidas en orden de mayor a menor frecuencia por la colecistitis, pancreatitis y obstrucción intestinal (2,7). Actualmente, su diagnóstico recae en los signos vitales, el análisis de sangre y el examen físico, sin embargo, representa todo un desafío para el médico debido a la gran cantidad de cambios anatomofisiológicos que ocurren durante el embarazo.…”