Appendicitis in Pregnancy: How Vestigial is this?

Abstract

Introduction Appendicitis is the inflammation of appendix, rarely associated with pregnancy with an estimated frequency of one per fifteen hundred pregnancies [1,2]. Appendectomy is a most common non obstetrical surgical procedure in a pregnant patient [1]. The accurate diagnosis of acute appendicitis in pregnancy is usually obscured due to gestational physiological changes. Delay in diagnosis enhances risk of appendiceal perforation, hence rising maternal and fetal morbidity and mortality. Symptoms and signs of appendicitis in pregnancy are quite enigmatic as they often vary with the varying trimester of pregnancy due to changing anatomical location of appendix with consequent enlargement of uterus. Appendicitis occurs most commonly in the first and second trimester but can occur at any gestation [1]. Here we are presenting two cases of acute appendicitis with pregnancy, out of which 1 patient died. Appendicitis is a rare pregnancy associated surgical emergency, with appendectomy as the most frequent non obstetrical surgical procedure performed in pregnancy. Diagnostic delay increases maternal and fetal morbidity and mortality thereby highlighting the need for a prompt diagnosis and surgery. Two cases of appendicitis with pregnancy are being reported with abdominal pain as common presenting feature. One of these patients had fatal outcome probably due to delayed presentation, the other, however, was successfully managed with early surgical intervention leading to normal maternal and fetal outcome. Early surgical intervention in such cases merely on the basis of high index of suspicion is being emphasized. Abstract