Acute appendicitis in pregnancy: literature review

Abstract

Conflict of interest: noneIntroduction: suspected appendicitis is the most common indication for surgery in non-obstetric conditions during pregnancy and occurs in about one in 500 to one in 635 pregnancies per year. This occurs more often in the second trimester of pregnancy. Acute appendicitis is the most common general surgical problem encountered during pregnancy. Methods: a literature review on research of scientific articles, under the terms "acute appendicitis" and "pregnancy", in PubMed, Lilacs/SciELO, Scopus, Cochrane Library and Uptodate databases.Results: the clinical manifestations of appendicitis are similar to non-pregnant women, however, without a classic presentation, which often occurs, diagnosis is difficult and must be supported by imaging. Discussion: clinical diagnosis should be strongly suspected in pregnant women with classic findings such as abdominal pain that migrates to the right lower quadrant. The main purpose of imaging is to reduce delays in surgical intervention due to diagnostic uncertainty. A secondary objective is to reduce, but not eliminate, the negative appendectomy rate. Differential diagnosis of suspected acute appendicitis usually includes pathologies considered in non-pregnant people. Conclusion: the imaging study of choice is ultrasound, MRI may be used when the former is not conclusive and, as a last resort, a CT scan can be performed. The treatment remains appendectomy by laparotomy, since the feasibility of video-assisted surgery in these cases remains controversial.

Predictive role of neutrophil‐to‐lymphocyte and platelet‐to‐lymphocyte ratios for diagnosis of acute appendicitis during pregnancy

“…Ultrasound scans can be difficult to interpret because of the displacement of the appendix and cecum secondary to enlargement of the uterus [4]. Furthermore, MRI is not always readily available in the emergency setting, and CT involves exposure to ionizing radiation [6,9]. Another factor that can complicate the diagnosis of AA is the physiological leukocytosis of pregnancy, which increases with gestational age [5,6].…”

“…However, physiological leukocytosis occurs in pregnancy, and the WBC count increases with gestational week to reach a peak during labor. Therefore, an increased WBC count is not a specific parameter for the diagnosis of AA in pregnancy [5,6]. The level of CRP, an acute phase reactant, increases in many inflammatory conditions and can be used in the diagnosis of AA [7]; however, the CRP level may also be increased in healthy pregnant women [8].…”

“…The level of CRP, an acute phase reactant, increases in many inflammatory conditions and can be used in the diagnosis of AA [7]; however, the CRP level may also be increased in healthy pregnant women [8]. Ultrasonography is the most frequently used imaging modality to diagnose AA, but the appendix may be difficult to visualize in pregnancy because of anatomical changes [6]. Magnetic resonance imaging (MRI) and computed tomography (CT) are of limited use in pregnancy because MRI is not widely available and CT involves exposure to ionizing radiation [6,9].…”

“…Ultrasonography is the most frequently used imaging modality to diagnose AA, but the appendix may be difficult to visualize in pregnancy because of anatomical changes [6]. Magnetic resonance imaging (MRI) and computed tomography (CT) are of limited use in pregnancy because MRI is not widely available and CT involves exposure to ionizing radiation [6,9]. The Alvarado scoring system, first described in 1986 [10] and based on clinical and laboratory data, is recommended for use in the diagnosis of AA.…”

Review of Operative vs. Non-Operative Management of Appendicitis in Pregnancy

“…As laparoscopy became adopted by general surgeons and gynecologists for non-obstetric procedures, controversy grew over optimal approaches to the treatment of acute appendicitis in the pregnant patient. Pregnancy was initially considered a contraindication to laparoscopy [87] and subsequent papers questioned whether laparoscopic appendectomy was feasible in pregnant patients [88]. Challenges of performing laparoscopy during pregnancy include difficult visualization due to gravid uterus with laparoscope and potential risk of decreased blood flow due to increased intraabdominal pressure, possible carbon dioxide absorption for the mother or fetus [89].…”