Ninety‐four Appendectomies for Suspected Acute Appendicitis during Pregnancy

Abstract

Acute appendicitis during pregnancy is a rare event, and large numbers of cases reported in the literature stem entirely from data stored in national registers. Between 1974 and 2000 relevant perioperative data on the treatment of appendicitis were collected consecutively and analyzed retrospectively. Surgical and obstetric data relating to the medical history, the clinical, intraoperative, and histologic findings, and the course of the pregnancy were recorded. Altogether, 9793 appendectomies were performed, 94 of which were in pregnant women (24.5% during the first trimester, 51% during the second trimester, and 24.5% during the third trimester). This represents 0.2% of the 46,960 deliveries during the period under observation. Fifty percent of the case histories during the second trimester were atypical. The overall perforation rate was 14.9%; it was 8.7%, 12.5%, and 26.1% during the three trimesters, respectively. Maternal mortality was 0%; the combined miscarriage/abortion rate was 8.5% (n = 8); and infant mortality was 3.2% (n = 3). The postoperative spontaneous abortion rate was 13.0% and the additional therapeutic/requested abortion rate 21.7% during the first trimester. In view of the elevated postoperative abortion rate and the facility of the clinical diagnosis during the first trimester, the indication for invasive diagnostic measures and surgery requires careful consideration. During the second and third trimesters the difficulty of establishing a clinical diagnosis makes it necessary to undertake exploratory surgery early.

Laparoscopic versus open appendectomy during pregnancy

“…20 The rate of negative appendectomy during pregnancy (by postoperative pathology) had been reported between 25-50% by Brown et al and Ueberrueck et al, in this study it was reported that postoperative normal appendix was reported in 3 patients that represent 14%. 16,21 Walsh et al reported 1% as a rate of conversion of laparoscopic to open appendectomy. In this study, none of our procedure converted from laparoscopic to open appendectomy.…”

Acute Appendicits in Pregnancy: Evaluation of 129 Patients During 20 years

“…Yet, no etiology was found in four cases although they were analyzed for familial mediterranean fever. Acute patients should be promptly evaluated and diagnosed so as to prevent perforation and negative laparotomies [6,14,15]. Prompt intervention to be performed within 24 hours after the onset of symptoms will reduce the risk of fetomaternal morbidity and fetal mortality.…”

“…High rates of perforation were confirmed in our delayed patients. Perforation rate and negative laparotomy rate during pregnancy are reported to be 12 -55% [6,14,15] and 13 -50% [17,19], respectively. We found the perforation rate as 28.7% and negative laparotomy as 11.6% between 2005 -2010 in our department.…”

“…However, the risk of delay in diagnosis, resulting from the absence of specific signs in physical examination and from anatomic and physiological changes, is associated with a greater risk of fetal or maternal morbidity and fetal loss [4,5]. The incidence rate of perforated appendicitis due to delayed diagnosis in preoperative period is greater in pregnant women [6,7]. The aim of the present study is to discuss acute appendicitis in pregnancy, along with maternal and fetal complications, in an attempt to present ideal medical approaches to be employed in patient management.…”

Appendicitis in Pregnancy: Presentation, Management and Complications

“…Acute appendicitis has a peak incidence in the second and third decades coinciding with the childbearing years [3]. Accurate diagnosis is difficult with the typical clinical picture being present in only 50% -60% of cases [4,5]. With increasing gestational age reduces diagnostic accuracy and is associated with increased rates of appendiceal perforation and hence complications [6].…”