Sonography of acute appendicitis in pregnancy

Barloon, Thomas J.; Brown, Bruce P.; Abu‐Yousef, Monzer M.; Warnock, Niall G.; Berbaum, Kevin S.

doi:10.1007/bf00201525

Cited by 64 publications

(35 citation statements)

References 11 publications

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“…Barloon et al reported a diagnostic accuracy of 91% for diagnosing appendicitis in a series of 22 cases. All of the patients were in the first and second trimester in this study; however, it is not clear if the appendix was visualized in all cases or if the ultrasound was considered negative for appendicitis even if the appendix was not visualized [31].…”

Section: Discussionmentioning

confidence: 90%

Utility of ultrasound for evaluating the appendix during the second and third trimester of pregnancy

et al. 2012

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This study aims to retrospectively evaluate the right lower quadrant ultrasounds in women presenting during the second or third trimester of pregnancy for the frequency of appendix visualization and accuracy in diagnosing appendicitis. Institutional Review Board approval was obtained for this Health Insurance Portability and Accountability Act-compliant study. We reviewed imaging records from 99 consecutive pregnant women from 2001 to 2011 who presented during the second (≥14 weeks gestation) or third trimester for right lower quadrant ultrasound to evaluate the appendix. Visualization of the appendix as well as the size and compressibility, if identified, were recorded. The medical records and labs related to the initial patient presentation, subsequent management, and follow-up were reviewed for surgical and clinical outcomes. Pathology records were reviewed to determine if appendicitis was present when appendectomy was performed. Patients who underwent appendectomy were considered to have appendicitis based on pathology results, and patients managed non-operatively with symptom improvement and those with a normal appendix at pathology were considered to not have appendicitis. During the study period, 99 women meeting inclusion criteria presented to our institution for right lower quadrant ultrasound to evaluate the appendix during the second or third trimester of pregnancy. The mean gestational age at presentation was 23 weeks (±7 weeks). The mean maternal age was 28 years (±6.6 years). The appendix was not visualized in 97% (96/99) of right lower quadrant ultrasound examinations. Of the three studies in which the appendix was visualized, two were considered positive for appendicitis and one was considered negative. Eight patients in this group ultimately underwent appendectomy, including the two patients with positive right lower quadrant ultrasounds, and appendicitis confirmed at pathology in seven of these cases (87.5%). Right lower quadrant ultrasound successfully demonstrated an abnormal appendix in 28.7% (two of seven) of surgically confirmed cases; however, this technique did not detect appendicitis in 71% (five of seven) of patients with surgically proven disease due to nonvisualization of the appendix. Retrospective review of right lower quadrant ultrasounds performed during the second and third trimester of pregnancy suggests that this modality has limited utility for diagnosing appendicitis due to infrequent visualization of the appendix.

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Section: Discussionmentioning

confidence: 90%

Utility of ultrasound for evaluating the appendix during the second and third trimester of pregnancy

et al. 2012

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“…3,7-9 Potential enthusiasm for routine use of CT scans in diagnosing appendicitis in pregnancy is of set by concerns for ionizing radiation exposure to the mother and fetus. 3,10 In the general population, the reported overall negative appendectomy rate (NAR) after an appendectomy for clinical diagnosis of acute appendicitis without imaging is reported to be as high as 25%. 11 The increased use of ultrasound (US) and/or computed tomography (CT) scan has reportedly improved the overall NAR in the general population to <15%.…”

Section: Introductionmentioning

confidence: 99%

Influence of Imaging on the Negative Appendectomy Rate in Pregnancy

Wallace

Petrov

Soybel

et al. 2008

Journal of Gastrointestinal Surgery

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Appendectomy is the most common non-gynecologic surgery performed during pregnancy. Little data exist on the accuracy of imaging studies in the diagnosis of appendicitis in pregnancy. The objective of this study was to evaluate the probability of ultrasound and computed tomography (CT) scan in diagnosing appendicitis in pregnancy, as reflected in the negative appendectomy rate. We retrospectively reviewed the charts of 86 pregnant women who underwent an appendectomy between January 1, 1997 and January 1, 2006. Patients were divided into three groups: clinical evaluation, ultrasound, and ultrasound followed by a CT scan. The clinical evaluation group had 13 patients, with a negative appendectomy rate of 54% (7/13). Fifty-five patients underwent an ultrasound alone, with a negative appendectomy rate 36% (20/55). In the ultrasound/CT group (n=13), the negative appendectomy rate was 8% (1/13). There was a significant reduction in the negative appendectomy rate in the ultrasound/CT scan group compared to clinical evaluation group (54 vs 8%, p<0.05). This reduction was not achieved in the ultrasound group when compared to the clinical evaluation group or the ultrasound/CT group (p=0.05). A significant reduction was achieved when the ultrasound/CT group was compared to the patients in the ultrasound only group who had a normal or inconclusive ultrasound (p<0.05). Our data documents a very high negative appendectomy rate in the pregnant patient. We recommend an ultrasound followed by a CT scan in patients with a normal or inconclusive ultrasound.

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“…In the third trimester, visualization improved when the patient was imaged in the left lateral decubitus position (40). Another study of 22 pregnant patients (all in the first and second trimesters) reported 66% sensitivity and 95% specificity (41).…”

Section: Role Of Graded Compression Usmentioning

confidence: 99%

“…Imaging findings diagnostic of appendicitis at US are a blind-ended nonperistaltic tubular structure arising from the base of the cecum (usually at the site of tenderness) measuring more than 6 mm in diameter (7 mm in some articles), with a thick wall and associated inflammatory changes in the mesenteric fat. When an appendicolith is present, it is usually associated with marked acoustic shadowing (40,41).…”

Section: Role Of Graded Compression Usmentioning

confidence: 99%

Imaging the Pregnant Patient for Nonobstetric Conditions: Algorithms and Radiation Dose Considerations

Patel

Reede²,

Katz³

et al. 2007

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Use of diagnostic imaging studies for evaluation of pregnant patients with medical conditions not related to pregnancy poses a persistent and recurring dilemma. Although a theoretical risk of carcinogenesis exists, there are no known risks for development of congenital malformations or mental retardation in a fetus exposed to ionizing radiation at the levels typically used for diagnostic imaging. An understanding of the effects of ionizing radiation on the fetus at different gestational stages and the estimated exposure dose received by the fetus from various imaging modalities facilitates appropriate choices for diagnostic imaging of pregnant patients with nonobstetric conditions. Other aspects of imaging besides radiation (ie, contrast agents) also carry potential for fetal injury and must be taken into consideration. Imaging algorithms based on a review of the current literature have been developed for specific nonobstetric conditions: pulmonary embolism, acute appendicitis, urolithiasis, biliary disease, and trauma. Imaging modalities that do not use ionizing radiation (ie, ultrasonography and magnetic resonance imaging) are preferred for pregnant patients. If ionizing radiation is used, one must adhere to the principle of using a dose that is as low as reasonably achievable after a discussion of risks versus benefits with the patient.

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Sonography of acute appendicitis in pregnancy

Abstract: Our experience suggests that graded-compression sonography is a useful procedure in pregnant patients suspected of acute appendicitis and has a similar accuracy as in nonpregnant women, especially in the first and second trimester.

Cited by 64 publications

References 11 publications

Utility of ultrasound for evaluating the appendix during the second and third trimester of pregnancy

Utility of ultrasound for evaluating the appendix during the second and third trimester of pregnancy

Influence of Imaging on the Negative Appendectomy Rate in Pregnancy

Imaging the Pregnant Patient for Nonobstetric Conditions: Algorithms and Radiation Dose Considerations

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