The Significance of Clinical Signs and Blood Indices for the Diagnosis of Appendicitis during Pregnancy

Abstract

Objective: To evaluate the significance of clinical signs and blood indices for the diagnosis of appendicitis during pregnancy. Sample: Of the 40,112 women delivering at our institution (January 1995 to June 2002), 38 women (0.094%) were operated due to the suspicion of appendicitis during pregnancy. Methods: Body temperature, clinical examination, white blood cell counts and lag time from arrival to operation were obtained for each patient. All women were operated with the clinical diagnosis of appendicitis, and their appendices were removed and examined by a pathologist. Results: Inflammatory appendix was discovered in 19 (0.047%) of the pregnancies with subsequent deliveries while a normal appendix was found in 19 of the 38 (50%) appendices removed. The group with normal appendix did not significantly differ from women with inflamed appendix with regard to gestational age at presentation, signs of peritoneal irritation, body temperature, leukocyte count, time elapsed between arrival and surgery, gestational age at delivery and birth weight. Conclusions: The accurate diagnosis of appendicitis during pregnancy is a difficult task requiring a very high level of suspicion and clinical skills and not merely relying upon laboratory and classic signs.

Appendicitis in Pregnancy: Presentation, Management and Complications

“…Correct clinical diagnosis in young women also is more difficult and reported higher negative appendectomy rate in this age group [14]. Furthermore most of our cases were in third Trimester66% (N = 41) with increasing gestational age reduces diagnostic accuracy and is associated with increased rates of appendiceal perforation and hence complications [28].…”

“…In our study, 76% of positive appendicitis had leukocytosis, more than 10,000, but leukocytosis in 70% negative appendicitis also occurred, thus leukocytosis, could not as a diagnostic measure considered. Mild to moderate leukocytosis are features common to both acute appendicitis and normal pregnanc [12,28]. polymorfonuclear also was increased both in positive and negative appendectomy and had no role in increasing diagnosis.…”

“…The negative laparotomy rate for suspected appendicitis in obstetric cases were reported 25% -50%, in nonobstetric patients 15% -35% [28]. Correct clinical diagnosis in young women also is more difficult and reported higher negative appendectomy rate in this age group [14].…”

MRI for Suspected Appendicitis in Pregnancy

“…Ultrasound is usually the first step of image modalities. However, ultrasound highly depends on operators' experience, and will be interfered by intestinal gas and enlarged uterus [7][8][9]. Computer tomography will not be taken into consideration because of radiation exposure, although present guidelines ensure fetal safety with exposure dose less than 5 rads [10,11].…”

Outcomes of the patients diagnosed incidentally appendicitis during cesarean section

“…Appendiceal rupture occurs more frequently in pregnant women, especially in the third trimester, possibly because these challenges and reluctance to operate on pregnant women delay diagnosis and treatment [2,3]. Although the clinical presentation and the course of acute appendicitis is similar in pregnant and non-pregnant patients, physiological and anatomical changes occurring in pregnancy lead to difficulty and/or delays in diagnosis [4,5]. Anorexia, nausea, vomiting, peri-umbilical or right lower quadrant pain and mild to moderate leukocytosis are common features in both acute appendicitis and normal pregnancy [6].…”