The diagnosis of acute appendicitis in pregnant versus non-pregnant women: A comparative study

Abstract

ArAs A et Al. 622rev assoC med bras 2016; 62(7):622-627 ORIGINAL ARTICLEThe diagnosis of acute appendicitis in pregnant versus non-pregnant women: A comparative study Objective: To investigate whether the diagnosis of acute appendicitis is affected by pregnancy or not. Method: A retrospective study with the analysis of the medical records of all women suspected of having appendicitis who underwent appendectomy at our hospital between June 2010 and March 2015 were reviewed. The patients were divided into two groups according to whether they were pregnant or not during the surgery: group I, pregnant women, and group II, non-pregnant women.Results: During the study period, 38 pregnant women and 169 non-pregnant women underwent appendectomy. The time from admission to the operation was not statistically different (2.17±1.47 days in group I vs. 1.98±1.66 day in group II; p=0.288). The pregnant group had longer hospital stay than the nonpregnant group (p=0.04). Ultrasonography (USG) was used as the first diagnostic modality in 36/38 patients in group I and 161/169 in group II. The non-visualized appendix on ultrasound was seen in 17 patients in group I and 51 patients in group II, which was not statistically different. Sensitivity and specificity of USG in diagnosis of acute appendicitis were 61.29 and 80.00% in group I, and 93.0 and 31.6% in group II, respectively. Conclusion: Although the diagnosis of appendicitis in pregnant women is not delayed, careful assessment of these patients suspected of having appendicitis should be encouraged when USG examination is normal or nondiagnostic.

Diagnosis, Management and Clinicopathological Features of Acute Appendicitis in Pregnant Women and Its Impact on Fetal Outcomes

“…Currently, the main surgical technique in the management of acute appendicitis during pregnancy is yet to be established. The preferred surgical method is based upon the trimester of pregnancy and the surgeon's own preference (3,9,13,24). Our findings indicated that the laparoscopic management of appendicitis was more frequently used in the non-pregnant women than in the pregnant women.…”

“…It has been reported that the preoperative diagnosis of appendicitis can be difficult during pregnancy. Anatomical and physiological changes in pregnancy may make the diagnosis more uncertain and delay the treatment of appendicitis (3,5,10,14,18). While nausea and vomiting occur frequently during pregnancy, rebound tenderness and guarding are not often seen in pregnant women with appendicitis due to the shift of the appendix upward and laterally as the uterus grows, which results in diminished response to peritoneal irritation (9,19).…”

“…In the current study, US was used preoperatively in all women to be sure of an accurate diagnosis of appendicitis and to avoid unnecessary surgery. It has been reported that US yields a high rate of non-visualization of the appendix during pregnancy in up to 75% of cases (9,15) and a low sensitivity in 36%-71% of cases (3,6,13). These results can be explained by the fact that the use of US is limited due to its high operator dependence.…”

“…During pregnancy, acute appendicitis is the most common condition occurring at a frequency of one in 500-1000 births, and it necessitates nonobstetric emergency surgery (1). It is usually difficult to diagnose acute appendicitis during pregnancy because non-specific symptoms such as nausea, vomiting, loss of appetite, and abdominal pain are often the case in appendicitis as well as pregnancy, and the classic signs of appendicitis can also be masked by physiologic leukocytosis, altered anatomical position of the appendix and increased abdominal wall laxity, especially during late pregnancy (2,3). Also, due to the fact that diagnosing appendicitis in women is difficult, up to 50% of patients are misdiagnosed in the preoperative period (2,4,5).…”

Comparison of Demographic and Clinical Features of Pregnant and Non-pregnant Patients Undergoing Appendectomy

“…underdiagnosis in pregnant patients results in perforation and peritonitis, which leads to unfavorable complications of early delivery, miscarriage, fetal loss, and maternal mortality. [4] This study presented aims, first of all, compare demographic, biochemical and histopathological features of pregnant and non-pregnant female patients admitted to our surgery clinic instruction with an initial diagnosis of AAp. The second aim is to present maternal and fetal complication following appendectomy among pregnant patients.…”