Appendicitis in Pregnancy

Česká verzia

Authors: L. Lakyová ¹; J. Belák ²; M. Kudláč ²; J. Vajó ²; T. Toporcer ¹; J. Radoňak ¹
Authors place of work: I. chirurgická klinika Lekárska fakulta Univerzity Pavla Jozefa Šafárika, Fakultná nemocnica L. Pasteura, Košice, Slovenská republika, prednosta kliniky: prof. MUDr. Jozef Radoňak, CSc. ¹; II. chirurgická klinika lekárska fakulta Univerzity Pavla Josefa Šafárika, Fakultná nemocnica L. Pasteura Košice, Slovenská republika, prednosta kliniky: MUDr. Jozes Belák, Ph. D. ²
Published in the journal: Rozhl. Chir., 2008, roč. 87, č. 10, s. 536-541.
Category: Monothematic special - Original

Summary

The aim of the study was to highlight the problems related to acute appendicitis in pregnancy. We present our own experiences with the diagnostics and therapy of this surgical complication during gravidity.

Nausea, vomiting and pain in lower right abdomen as symptoms of appendicitis are often confused with the I. trimester gravidity symptoms. The change of pain locality and the loss of somatic pain in the II. and the III. trimester cause diagnostic delay and increase the incidence of appendiceal perforation. In case of suspected appendicitis, when evaluating laboratory parameters, the common finding of leucocytosis during gravidity further complicates the differential diagnosis. In comparison to common population, ultrasonography in gravidity displays lower sensitivity and specificity.

Material and results:
In the course of the last ten years, 9 gravid women in the age (25.6 ± 3.9) underwent appendectomy in the 2nd surgical clinic FNLP in Košice. This represents 0.6 percentage incidence of appendicitis of 1496 patients operated because of this diagnosis. One of the patient turned out to be a case of negative appendectomy while the rest had histologically confirmed gangrenous (5x), phlegmonous (1x) and catarrhalis appendicitis (2x). Perforation was encountered in one patient. In the physical examination dominated pain in the right hypogastrium, nausea and subfebrility. The diagnostic success of USG examination reached 40%. In all gravid patients leucocytosis was found, including a negative appendectomy. The average duration from hospitalization to operation was 38 hours. No maternal or fetal loss was noted.

Conclusions:
Correct diagnostic and early surgical intervention prevents further fetal and maternal morbidity and mortality. Physical examination is important in differential diagnosis. Leucocytosis is not a predictive marker of appendicitis. Visualization of appendix through ultrasonography is rather difficult in the third trimester.

Key words:
appendicitis – pregnancy – USG – inflammatory markers

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