Appendicitis in pregnancy, Diagnosis, management and complications

Andersen, Bjørg Marit; Nielsen, ThorkildF.

doi:10.1080/j.1600-0412.1999.780903.x

Cited by 165 publications

(112 citation statements)

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“…According to one review, histologically proven appendicitis was found in 22% of previously healthy nonpregnant patients with pneumococcal peritonitis [7]. Signs and symptoms of appendicitis can be suppressed during pregnancy, and local inflammatory changes might be less prominent [8], causing a delay in diagnosis and treatment.…”

Section: To the Editorsmentioning

confidence: 97%

Primary pneumococcal peritonitis in pregnancy

Weizsaecker

Michaelis

Dudenhausen

2010

The Journal of Maternal-Fetal & Neonatal Medicine

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To the Editors,We report a case of primary pneumococcal peritonitis in a previously healthy pregnant woman without identifiable source of infection. A 22-year-old nullipara presented at 24-weeks gestation with a 1-day history of severe abdominal pain and nausea. She had no other pertinent illness and denied illicit drug or alcohol use. A test for HIV had been negative during the pregnancy. Her oral temperature was 38.18C. She had diffuse abdominal tenderness with rebound and guarding. Bowel sounds were absent. The physical examination was otherwise unremarkable. The laboratory workup was significant for leukocytosis (39200/ml) and an elevated C -reactive protein of 42.7 mg/dl (normal range 50.5 mg/dl). Ultrasonographic examination showed an appropriate for gestational age fetus with normal amniotic fluid volume and flow indices in the umbilical and middle cerebral arteries. Diagnostic laparoscopy revealed a moderate amount of purulent fluid in the abdominal cavity. Appendix, ovaries, Fallopian tubes, gall bladder, and all intraperitoneal segments of small and large intestines appeared unremarkable except for mild inflammatory changes. Cultures were taken and the abdomen irrigated thoroughly with normal saline. Antibiotic treatment with cefuroxime and metronidazole was initiated, and the patient's condition improved rapidly. The intraperitoneal cultures grew Streptococcus pneumonia. Vaginal and cervical swabs revealed only physiological flora, blood and urine cultures were negative. A transthoracic echocardiogram to rule out endocarditis and a thorough examination of the patient's upper respiratory tract were performed without any evidence of infection. Pharyngeal cultures taken 3 days after the initiation of antibiotic therapy were also negative. As

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Section: To the Editorsmentioning

confidence: 97%

Primary pneumococcal peritonitis in pregnancy

Weizsaecker

Michaelis

Dudenhausen

2010

The Journal of Maternal-Fetal & Neonatal Medicine

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“…Acute appendicitis is the most common surgical emergency in pregnancy and is associated with fetal loss and maternal death 1314. A fetal loss rate of 8% was reported in a Turkish study of 52 women with acute appendicitis who underwent surgery 15.…”

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confidence: 99%

Imaging of acute abdominal pain in the third trimester of pregnancy

Shur

Bottomley

Walton³

et al. 2018

BMJ

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“…

Appendicitis in pregnancy 277because the rate of fetal loss and early delivery in women with perforated appendicitis is substantially higher then cases of simple appendicitis [6][7][8]11,18 .Curiously, the risk of acute appendicitis is lower in the pregnant than the nonpregnant female population, with the majority of cases in pregnancy occurring in the second trimester 4,9,13,19 . Andersson et al 19 found there to be an inverse relationship between pregnancy and appendicitis.

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confidence: 99%

“…

Appendicitis in pregnancy 277

because the rate of fetal loss and early delivery in women with perforated appendicitis is substantially higher then cases of simple appendicitis [6][7][8]11,18 .

Curiously, the risk of acute appendicitis is lower in the pregnant than the nonpregnant female population, with the majority of cases in pregnancy occurring in the second trimester 4,9,13,19 . These include: feelings of malaise, nausea/vomiting, constipation/bowel irregularity, urinary frequency, abdominal and pelvic discomfort and leukocytosis 4,7,[9][10][11] .The most common clinical presentation is vague pain in the lower right quadrant with rebound tenderness 4,6,12,13,18,21 . Furthermore, they postulated that this relationship may be linked to the hypothesis of Wegmann et al 20 who thought that the immune system favours humoral immunity mediated by TH2 cells during pregnancy.

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confidence: 99%

“…Furthermore, they postulated that this relationship may be linked to the hypothesis of Wegmann et al 20 who thought that the immune system favours humoral immunity mediated by TH2 cells during pregnancy. However, isolated nausea is common in normal pregnancy and is not a specific symptom of appendicitis 6,7,12,13,18 . It is important to note that the pathophysiology of appendicitis is still not completely understood and these connections remain hypotheses.…”

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Appendicitis in Pregnancy

Windrim

Czikk

2012

Fet. Matern. Med. Rev.

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Acute appendicitis is the most common non-obstetric indication for surgical intervention in pregnancy, complicating 1/500 to 1/2000 deliveries. Due to the anatomical and physiological changes associated with pregnancy, appendicitis may present a diagnostic dilemma, leading to management delays and thus increasing the risk of appendiceal perforation. Many of the common presenting symptoms of appendicitis are common features of normal pregnancy including lower abdominal pain, nausea, vomiting and leukocytosis. Furthermore, the enlarging gravid uterus may displace the appendix to varying degrees thus altering the classic symptom pattern of appendicitis. The often nonspecific presentation in pregnancy may necessitate the utilization of diagnostic imaging to aid in accurate diagnosis. However, the perforated appendix is the most common surgical cause of fetal loss and the time required for any diagnostic aid must be weighed against the increasing risk of perforation caused by delay in surgical intervention.

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Appendicitis in pregnancy, Diagnosis, management and complications

Cited by 165 publications

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Primary pneumococcal peritonitis in pregnancy

Primary pneumococcal peritonitis in pregnancy

Imaging of acute abdominal pain in the third trimester of pregnancy

Appendicitis in Pregnancy

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