Appendicitis in Pregnancy

20 May

-Most common non-gynecologic surgical emergency in pregnancy

-Incidence is around 1 in every 500 pregnancies, which is similar incidence in non-pregnant patients

-Most often during 2nd-3rd trimesters

-Higher rate of perforations than in non-pregnant patients

 

Diagnosis Difficulties:

Symptoms are common in normal pregnancy- abdominal pain, nausea, anorexia, vomiting

-Appendix location is often displaced by the uterus making localization less specific

-more commonly move from Right lower quadrant to right umbilical/right upper quadrant

-With displacement of the appendix from the peritoneum, difficult at times to elicit tenderness

-Less than one third of pregnant patients in one study had obturator/Psoas/Rovsing’s Signs.

 

Diagnosis:

Ultrasonagraphy is useful in first trimester but less useful in 2nd/3rd trimesters

MRI is the next preferred imaging modality

-Depending on gestation, CT may also be considered but is less preferred than MRI

-Labwork: Leukocytosis can be present but is neither sensitive/specific

 

Ruptured Appendix:

-Associated with increased rates of fetal loss and preterm labor

-Higher rates in 3rd trimester

 

Treatment:

Antibiotics, with surgical removal of the appendix

-Some studies have shown an increased risk of fetal loss with laparascopic approach compared with open approach

 

Submitted by J. Grover.

 

References:  Guttman R et al. Appendicitis During Pregnancy. Can Fam Physician 2004 Mar;50:355-357.; Jung SJ et al. Appendicitis During Pregnancy: The Clinical Experience of a Secondary Hospital. J Korean Soc Coloproctol. 2012; 28 (3): 152-159.; Walsh CA, Tang T, Walsh SR. Laparascopic Versus Open Open Appendicectomy in Pregnancy: a Systematic Review. Int J Surg. 2008 Aug; 6 (4):339-344.; picture

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