Acute appendicitis in pregnancy

Abstract

Acute appendicitis is the most frequent non-obstetrical surgical emergency encountered in pregnancy with negative maternal and fetal outcomes, mostly attributed to appendicular perforation. The purpose of this article is to discuss the characteristics in diagnosing appendicitis in pregnancy, recommendations of management, as well as maternal and fetal outcomes. It is significantly challenging to diagnose appendicitis in pregnancy due to the anatomic displacement of the appendix caused by the enlargement of the uterus (which may cause uncommon symptomatology), the physiologic leukocytosis of pregnancy, the raised prevalence of abdominal discomfort along with the inability to perform computed tomography because of the radiation exposure of the fetus. These particularities may delay an accurate and timely diagnosis which is of utmost importance in order to avoid the significant complications associated with peritonitis. Rapid surgical intervention (especially laparoscopy) is recommended, nevertheless, the key in managing appendicitis in pregnant patients is finding a balance between the risk of delaying the diagnosis and consequent perforation against the risk associated with a negative appendectomy.