Acute Appendicitis in Pregnancy: How to Manage?

Abstract

A cute appendicitis during pregnancy is one of the most frequent non-gynecological and non-obstetric pathology requiring emergent intervention. [1, 2] Its incidence rate during pregnancy has been reported between 1:1000 and 1:1500. [1-3] Moreover, it is a condition that may complicate the pregnancy period. Acute appendicitis in pregnancy has a variable and non-specific clinical presentation. Pregnancy related localization change of appendix vermiformis according to the gestational age may mask or change the symptoms and physical examination findings with a remarkable risk of delay in diagnosis. [4, 5] Besides the ordinary complications of appendicitis, additional comorbidities for mother and fetus in these patients should also be kept in mind. [1-5] Objectives: Acute appendicitis during pregnancy may be associated with severe maternal and fetal complications. The clinical, laboratory and radiological parameters used in diagnosis and the effects of the surgical method and timing on the results are controversial. The present study aims to reveal the relationship between clinical approach, surgical treatment methods and complications in pregnant women with suspected acute appendicitis. Methods: Between December 2007 and August 2019, 21 pregnant women who underwent appendectomy were included in this study. Age, gestational age, complaints at admission, leukocyte count, radiological examination results, type of surgery (conven-tional or laparoscopic), histopathology results, time from admission to operation, maternal and fetal complications were retrospectively evaluated. Results: The number of patients who developed complications was six (28.6%). Three (14.3%) of these patients had preterm birth and three (14.3%) had an abortion. There was no statistically significant relationship between trimester and complication (p=0.747). Fourteen patients (66.7%) underwent laparoscopic surgery and seven patients (33.3%) underwent conventional surgery. Although the complication rate was higher in the laparoscopic group, there was no statistically significant difference (p=0.306). The fetal loss rate in the series was 14.3% and all were in the laparoscopic group. However, there was no statistically significant difference between the groups (p=0.158). Conclusion: Pregnancy-related limiting factors may complicate the diagnosis of acute appendicitis. These patients definitely need a more skeptical assessment and additional diagnostic tools beyond the standard clinical approach. Although laparoscopic appen-dectomy appears to be a safe option in treatment, its relationship with a higher risk of fetal loss should be kept in mind.