Appendicitis in pregnancy: a novel approach for diagnostic dilemma

Background: The preoperative diagnosis of acute appendic i t i s i s of ten inaccurate i n pregnant women, and complicated appendicitis is associated with a high rate of fetal loss. Objective: Our purpose was to elicit a better understanding of the presentation of acute appendicitis in pregnancy and to clarify diagnostic dilemmas reported in the literature. Study design: We retrospectively reviewed 15216 deliveries from June 2009 to December 2011. Selected records were reviewed for gestational age, signs and symptoms at presentation, complications and, histologic diagnosis of appendicitis. Results: Of 15216 deliveries, 15 (0.1%) were complicated by a preoperative diagnosis of probable appendicitis. Acute appendicitis was confirmed histologically in 12 (80%) of the 15 cases. Right-lower-quadrant pain was the most common presenting symptom regardless of gestational age (first trimester [100%]; second trimester, [80%]; and third trimester, [60%]). The mean maximal temperature for proven appendicitis was 37.6°C, in comparison with 37.8°C (not significant) for those with normal histologic findings. The mean leukocyte count in patients with proven appendicitis was 16.4 × 109/L (8.2-27.0 × 109/L), in comparison with 14.0 × 109/L (5.9-25.0 × 109/L) for patients with normal histologic findings. At the time of surgery, appendiceal perforation was found in 2 cases. Conclusion: Pain in the right lower quadrant of the abdomen is the most common presenting symptom of appendicitis in pregnancy Appendicitis in pregnancy: a novel approach for diagnostic dilemma Atul K Sharma1, Rakesh K Sharma2, Santosh K Sharma3 Sri Lanka Journal of Obstetrics and Gynaecology 2012; 34: 6-10 Research 1 Senior Resident, Department of General Surgery, 2 Associate Professor, Department of General Surgery, 3 Senior Demonstrator, Department of Biochemistry, Government Medical College, Kota, India. Correspondence: Atul K Sharma E-mail: [email protected] regardless of gestational age. Fever and leucocytosis are not clear indicators of appendicitis in pregnancy.