Update on the Management of Non-obstetric Acute Abdomen in Pregnant Patients

Barber-Millet, Sebastián; Bueno-Lledó, José; Castro, Pablo Granero; Gavara, Immaculada Gómez; Ballester, Neus; Domínguez, R.

doi:10.1016/j.cireng.2016.05.001

Cited by 18 publications

(16 citation statements)

References 55 publications

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“…Maternal mortality raises from 0 to 4% depending on perforation presence. Surgical intervention should take place as soon as possible, as a 24-h diagnostic delay implies an appendiceal perforation rate of 66% [ 2 ]. In the present clinical case, diagnostic delay presumably evolved to a situation of abdominal sepsis that demanded a damage control approach with open abdomen management.…”

Section: Discussionmentioning

confidence: 99%

“…Acute appendicitis is the main indication for surgery during pregnancy. It is estimated that acute appendicitis occurs between 0.06% and 0.28% [ 1 ] in the pregnant woman, 40% of cases taking place on the second trimester [ 2 ]. Although pregnancy is not a risk factor for acute appendicitis, appendix rupture is higher amongst pregnant women [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

“…It is estimated that acute appendicitis occurs between 0.06% and 0.28% [ 1 ] in the pregnant woman, 40% of cases taking place on the second trimester [ 2 ]. Although pregnancy is not a risk factor for acute appendicitis, appendix rupture is higher amongst pregnant women [ 2 ]. Physiologic changes during pregnancy and fear of using ionising radiation exams are some of the reasons that contribute to delayed diagnosis and consequently later surgical intervention and higher morbidity and mortality rates for mother and fetus.…”

Section: Introductionmentioning

confidence: 99%

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Laparostomy during pregnancy: A case report

Logrado

Constantino

Pereira

et al. 2018

International Journal of Surgery Case Reports

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HighlightsAcute appendicitis is the main indication for surgery during pregnancy.Although pregnancy is not a risk factor for acute appendicitis, appendix rupture is higher amongst pregnant women.During pregnancy, delayed diagnosis is the main factor for poor prognosis as it allows for disease progression.Laparostomy constitutes a damage control gesture,preventing abdominal compartment syndrome and allowing subsequent surgical revision.Principles of the abdominal sepsis and damage control approach are reproducible in the pregnant woman.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Laparostomy during pregnancy: A case report

Logrado

Constantino

Pereira

et al. 2018

International Journal of Surgery Case Reports

View full text Add to dashboard Cite

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“…The incidence of acute abdomen in pregnancy is rare, 1 in 500–635 patients 1. Out of all non-obstetric causes of acute abdomen during pregnancy which concern a general surgeon, appendicitis is the most common (0.05–0.13%), followed by bowel obstruction, volvulus, intussusception (1:1500–1:3000) and biliary disease and pancreatitis (1:5000) 2.…”

Section: Introductionmentioning

confidence: 99%

Meckel's diverticular perforation presenting as acute abdomen in the second trimester of pregnancy

Ahmed¹,

Chhabra

Kankaria

et al. 2016

BMJ Case Reports

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Meckel's diverticular perforation is a rare cause of acute abdomen during pregnancy. We report the case of a 24-year-old woman at 24 weeks of gestation who presented with abdominal pain for 4 days accompanied with abdominal distension, tenderness and guarding in right lower quadrant. Ultrasonography was inconclusive. The patient underwent exploratory laparotomy with the clinical suspicion of appendicular perforation peritonitis. Intraoperatively, a perforated Meckel's diverticulum was detected. Owing to gross contamination of the peritoneal cavity, a diverticulectomy with ileostomy was performed. She had a normal full-term vaginal delivery, and ileostomy was reversed 1 month after delivery. The physiological and anatomical changes in pregnancy can make a straightforward clinical diagnosis difficult. A high index of suspicion is required to prevent delay in diagnosis and surgical intervention, which could prove detrimental to the mother and fetus.

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“…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]. The long-term prognosis for women who have undergone appendectomy during pregnancy seems to be good, but data is limited to small observational series.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of the patients diagnosed incidentally appendicitis during cesarean section

et al. 2017

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Objectives: Appendicitis is the most common condition leading to an intraabdominal operation for a non obstetric problem in pregnancy and diagnosis of appendicitis is complicated by the physiologic and anatomic changes that occur during pregnancy. Although a surgical procedure carries the risk of fetal loss or preterm delivery, delay in diagnosis also increases the risk of complications in both mother and fetus. In this report we present our experience and analyze clinical characteristic and the pregnancy outcomes of appendicitis diagnosed incidentally during cesarean in the third trimester. Material and methods:The study population consisted of 23 pregnant women who were diagnosed incidentally with appendicitis during cesarean at Erzincan University Hospital between 2015 and 2016.Results: Appendectomy was performed on 23 patients during a caesarean section performed for any reason. The mean diameter of appendix was 7.82 ± 1.85 mm. The mean operation time was 67.39 ± 18.94 SD and antibiotic therapy was given to all patients. Postoperative complications were noted in 4 (17.4%) patients. Wound infection was seen in 4 (17.4%) patients, the other 19 patients revealed no postoperative complications. The mean of APGAR score of newborns in the postoperative period was 8.26 ± 0.86 SD and no complications were observed in both mothers and newborns. Histopathology of the specimen confirmed acute appendicitis in 23 (100%) cases. Conclusions:Acute appendicitis is a challenging diagnosis in the pregnant patient; however, early surgical intervention should be performed with any suspicion. The type of surgery depends on the surgeon's preference and experience.

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Update on the Management of Non-obstetric Acute Abdomen in Pregnant Patients

Cited by 18 publications

References 55 publications

Laparostomy during pregnancy: A case report

Laparostomy during pregnancy: A case report

Meckel's diverticular perforation presenting as acute abdomen in the second trimester of pregnancy

Outcomes of the patients diagnosed incidentally appendicitis during cesarean section

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