Location of the appendix in the gravid patient: A re-evaluation of the established concept

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Hodjati H, Kazerooni T(Shiraz University of Medical Sciences, Shiraz, Iran)BackgroundAppendicitis is the most common extrauterine disease that requires surgery during pregnancy. Appendicitis is associated with premature labor pains and spontaneous abortion. Many years ago, it was reported that pregnancy displaces the appendix upward. The position of the appendix during pregnancy was re-evaluated.Study designThis study group consisted of 165 pregnant women who had a cesarean section, 26 pregnant women with acute appendicitis, and 100 women with acute appendicitis who were not pregnant. The location of the base of the appendix was considered to have changed if it was at least 2 cm from McBurney's point.FindingsIn the cesarean section group, 15% had a position change for the appendix; in the pregnancy plus appendicitis group, 23% had a position change; and in the control group, 17% had a position change. These differences were not significant.ConclusionsThe findings of this study do not support changes in the position of the appendix in the majority of women with pregnancy. A high level of suspicion should be maintained in pregnant women with right lower quadrant pain. Larger studies should be conducted to define the position of the appendix during pregnancy.CommentA more complete description of the investigators' methodology would have strengthened this article considerably. The authors leave the reader to guess the following: Who evaluated the location of the appendix tip? What was their training? Were there multiple evaluators/observers? If so, what was the agreement between observers as to the location of the appendix tip? Even with these omissions, I found this study fun because it attempts to dispel a medical myth: that the uterus always displaces the appendix into the right upper quadrant as pregnancy progresses so that appendicitis in pregnant women presents as right upper quadrant pain. Hodjati and Kazerooni demonstrate that displacement of the appendix into the right upper quadrant is not the rule and that even minimal displacement of the appendix from McBurney's point occurs in a minority of pregnant women.The take-home message is that a high level of clinical suspicion is needed to quickly and correctly diagnose appendicitis in pregnant women. Put it back on the differential diagnosis list for right lower quadrant pain. Hodjati H, Kazerooni T (Shiraz University of Medical Sciences, Shiraz, Iran) BackgroundAppendicitis is the most common extrauterine disease that requires surgery during pregnancy. Appendicitis is associated with premature labor pains and spontaneous abortion. Many years ago, it was reported that pregnancy displaces the appendix upward. The position of the appendix during pregnancy was re-evaluated. Appendicitis is the most common extrauterine disease that requires surgery during pregnancy. Appendicitis is associated with premature labor pains and spontaneous abortion. Many years ago, it was reported that pregnancy displaces the appendix upward. The position of the appendix during pregnancy was re-evaluated. Study designThis study group consisted of 165 pregnant women who had a cesarean section, 26 pregnant women with acute appendicitis, and 100 women with acute appendicitis who were not pregnant. The location of the base of the appendix was considered to have changed if it was at least 2 cm from McBurney's point. This study group consisted of 165 pregnant women who had a cesarean section, 26 pregnant women with acute appendicitis, and 100 women with acute appendicitis who were not pregnant. The location of the base of the appendix was considered to have changed if it was at least 2 cm from McBurney's point. FindingsIn the cesarean section group, 15% had a position change for the appendix; in the pregnancy plus appendicitis group, 23% had a position change; and in the control group, 17% had a position change. These differences were not significant. In the cesarean section group, 15% had a position change for the appendix; in the pregnancy plus appendicitis group, 23% had a position change; and in the control group, 17% had a position change. These differences were not significant. ConclusionsThe findings of this study do not support changes in the position of the appendix in the majority of women with pregnancy. A high level of suspicion should be maintained in pregnant women with right lower quadrant pain. Larger studies should be conducted to define the position of the appendix during pregnancy. The findings of this study do not support changes in the position of the appendix in the majority of women with pregnancy. A high level of suspicion should be maintained in pregnant women with right lower quadrant pain. Larger studies should be conducted to define the position of the appendix during pregnancy.