The significance of hemogram on diagnosis of acute appendicitis during pregnancy

Abstract

BACKGROUND: Acute appendicitis (AA) is the most common emergency surgical condition during pregnancy after obstetric and gynecological pathologies. Urgent and accurate diagnosis of AA in pregnant patients reduces maternal and fetal morbidity/mortality rates. This study evaluated the significance of hemogram to diagnose AA during pregnancy.METHODS: Forty-seven pregnant patients operated for AA in the Ordu or Ondokuz Mayis University Medical School Hospitals between January 2007 and December 2017 were compared with 47 healthy pregnant women in terms of hemogram parameters, including the white blood cell (WBC) count, neutrophil count, lymphocyte count, platelet count, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), mean platelet volume (MPV), and red cell distribution width (RDW) values. The operated group was evaluated based on post-operative pathologic results and subclassified into appendicitis positive (Group A) and appendicitis negative (Group B) groups. The subgroups were compared to the control group. RESULTS:The WBC and neutrophil count and mean NLR and PLR values were significantly higher in Group A compared to Group B and the control group (p<0.001). The mean lymphocyte count was significantly lower in Group A compared to other groups (p<0.001). The MPV and RDW values and mean platelet count showed no significant difference between groups (p>0.05). When cutoff values for WBC,

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

“…However, a number of studies have indicated that there might be an increased risk of preterm delivery or fetal loss in those undergoing laparoscopic appendicectomy compared with those undergoing open appendicectomy (24,25). Whether the choice of incision should be transverse or oblique or at or above McBurney's point in pregnant women is also a controversial issue (18,26). Our study showed that oblique incisions at McBurney's point could be performed successfully in all pregnant patients.…”

“…As reported in another study, the contributions of inflammation markers alone are limited, and thus their use must only be to contribute to diagnosis together with physical examination and imaging tests (18).…”

“…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).…”

Is the platelet to lymphocyte ratio a promising biomarker to distinguish acute appendicitis? Evidence from a systematic review with meta-analysis

“…Twenty-four articles were retrieved and reviewed based on full text. Finally, 11 articles met the inclusion criteria and were included in our meta-analysis [26][27][28][39][40][41][42][43][44][45][46].…”

“…Ten of the 11 studies reported adult patients while one included pediatric patients [28]. Five studies extracted effect estimates using indirect methods proposed by Wan et al [26,27,40,41,45]. Most of the included studies were conducted in Europe and Asia.…”