Acute Appendicitis In Pregnancy Research Articles

Review on Common Non-Obstetric Acute Abdominal Conditions in Pregnancy: An Update of Management

Non-obstetric acute abdominal conditions account for admission to the surgical ward, and it involves management by the surgeon and gynecologists. The common conditions are acute appendicitis, acute cholecystitis and acute pancreatitis. Acute appendicitis in pregnancy requires prompt diagnosis and the management has moved towards laparoscopic appendectomy. Acute cholecystitis in pregnancy has seen a trend from conservative management to laparoscopic cholecystectomy being performed during pregnancy to prevent recurrence. Acute pancreatitis in pregnancy is usually managed conservatively with endoscopic retrograde cholangiopancreatography being performed for gallstone pancreatitis. We have conducted this review article to investigate the current management of these conditions.

Magnetic resonance imaging for acute appendicitis in pregnancy: can clinical scores predict when imaging is needed?

Advanced imaging may augment the diagnostic milieux for presumed acute appendicitis (AA) during pregnancy, however it is not clear when such imaging modalities are indicated. The aim of this study was to assess the sensitivity and specificity of clinical scoring systems with the findings on magnetic resonance imaging (MRI) of AA in pregnant patients. A retrospective cohort study between 2019 and 2021 was performed in two tertiary level centers. Pregnant patients presenting with suspected AA and non-diagnostic trans-abdominal ultrasound who underwent MRI as part of their evaluation were identified. Patient demographics, parity, gestation, presenting signs, and symptoms were documented. The Alvarado and Appendicitis Inflammatory Response (AIR) score for each patient were calculated and correlated with clinical and MRI findings. Univariate analysis was used to identify factors associated with AA on MRI. Of the 255 pregnant patients who underwent MRI, 33 (13%) had findings of AA. On univariate analysis, presentation during the second/third trimester, migration of pain, vomiting and RLQ tenderness correlated with MRI findings of AA. Whilst 5/77 (6.5%) of patients with an Alvarado score ≤4 had signs of AA on MRI, a score of ≥5 had a sensitivity, specificity, negative and positive predictive value of 84.8%, 36.6%, 94.0% and 17.2%. For an AIR score ≥ 5, this was 78.8%, 41.5%, 93.0%, and 16.7%, respectively. Whilst clinical scoring systems may be useful in identifying which pregnant patients require MRI to be performed when AA is suspected, the low sensitivity implies further research is needed to refine the use of this valuable resource.

Acute appendicitis in pregnancy, is there a role for conservative management?

Background: Although rare, acute appendicitis is the most common general surgery problem encountered in pregnancy. A chief concern is timely and accurate diagnosis. Traditionally, delayed diagnosis of appendicitis in pregnant patients can quickly lead to appendiceal rupture associated with miscarriage, premature delivery, or even fetal loss. Hence, appendectomy has been the gold standard. However, emerging evidence suggests conservative management may be more effective than previously thought, after accounting for maternal and fetal characteristics. Methods: This retrospective study included a sample of pregnant women diagnosed with acute appendicitis presenting for treatment to two hospitals in Queens, NY, between Jan 2012 and Dec 2021. The characteristics, presentation, and outcomes of conservatively versus surgically treated patients were compared. Results: The cumulative incidence of acute appendicitis was 0.11% (n=44/28,000). Forty were treated surgically: 78% underwent laparoscopic appendectomy, 15% open appendectomy, and 8% underwent an initial laparoscopy which was converted to an open appendectomy. Four (14%) patients were managed conservatively with IV antibiotics. Eight percent of patients treated surgically had postoperative complications. Neither surgical nor conservatively treated groups reported any instance of mortality or fetal demise. Conclusions: Our study adds to the literature on treatment decisions for pregnant patients with acute appendicitis. Although surgical intervention remains the gold standard, it carries the potential risk of peri- and postoperative complications. These findings suggest conservative management with antibiotics can sometimes be used without a negative impact on maternal or fetal outcomes.

Acute appendicitis in pregnancy

Introduction: The early diagnosis and management of appendicitis in pregnancy are essential in maternal and fetal morbidity and mortality. In this 20-year retrospective study, we aimed to assess the outcomes of pregnant patients diagnosed with acute appendicitis.Methods: A single-center retrospective study was carried out. Randomly selected 2000 medical records of pregnant mothers referred as outpatients and hospitalized from 2002 to 2022 were retrieved. Six pregnant patients who were diagnosed and treated in Nawaloka Hospital with the diagnosis of acute appendicitis during 2002-2022 were examined retrospectively. Ethics Committee approval was received. No conflicting interest.Results: The age range of our patients was 22 to 31 years, mean of 26± 3.4. The mean gestational week was 20±5.3 weeks, and most were in the second trimester 4 (68%). All patients were admitted with the complaint of abdominal pain, the majority of them had the right iliac fossa pain (RIF). All had elevated inflammatory markers. No computed tomography (CT) was performed. One patient was diagnosed clinically of having acute appendicitis without any imaging. Acute appendicitis was diagnosed in 3/5 patients who underwent ultrasound scan examination. The other two patients (one from 2nd trimester and one in the third trimester) were diagnosed with acute appendicitis on MRI examination. All patients underwent open appendectomy under general anaesthesia. No maternal or foetal morbidity or mortality was noted during pre or post-surgical and anaesthesia procedures. The mean hospital stay was 3.9±0.9 days. All appendixes were pathologically proven to have acute appendicitis. Except for minor superficial surgical site infection rest of the mothers and foetus had no morbidity or mortality recorded in the follow-up.Conclusion: Although appendicitis is not frequent during pregnancy, it is a disease that requires urgent surgical and obstetrics care for timely diagnosis and treatment.

Acute Appendicitis in Pregnancy-Current Management-Review Article

The management of acute appendicitis in pregnancy is considered controversial, as there is no consensus in terms of diagnosis, investigation, and treatment. Blood investigations like full blood count are of limited value due to the physiological changes that occur in pregnancy. The use of abdominal ultrasound has always been mandatory but magnetic resonance imaging (MRI) is slowly becoming an alternative in the investigation of this condition. Open appendectomy has always been the treatment of choice, but laparoscopic appendectomy is becoming an emerging trend in the management of acute appendicitis in pregnancy. We conducted this narrative review article to evaluate the diagnosis and management of acute appendicitis in pregnancy.

PARAMETERS ASSOCIATED WITH ACUTE APPENDICITIS IN PREGNANCY

Objective
 Acute appendicitis is the most common cause of nonobstetric
 acute abdomen in pregnant women. The
 fact that sympathomatology brings to mind primarily
 obstetric causes in pregnant patients, physiological
 leukocytosis is observed throughout pregnancy, and
 limitations in imaging methods cause confusion in the
 diagnosis. This makes the need for detailed evaluation
 in laboratory parameters inevitable. The aim of
 the study is to reveal the relationship of laboratory
 parameters such as neutrophil lymphocyte ratio
 (NLR), platelet lymphocyte ratio (PLR), lymphopenia
 with the diagnosis of appendicitis and its diagnostic
 power.
 Material and Method
 In the evaluation of 31 patients who were operated
 on with the diagnosis of acute appendicitis during
 pregnancy between January 2017 and February
 2021 were evaluated. Correlation and roc analysis
 were performed by evaluating patients' demographic
 data, laboratory results, ultrasonography or magnetic
 resonance imaging reports and intraoperative
 findings.
 Results
 A significant correlation was found between
 detection of appendicitis in exploration and increased
 neutrophils, leukocytosis, and NLR (p: 0.014, p:
 0.015, p: 0.020, respectively). Again, the presence
 of lymphopenia, high NLR and increased palletelet /
 lymphocyte ratio (PLR) were found to be associated
 with prolonged hospitalization (p:0.037, p:0.008, and
 p:0.024, respectively). Roc analysis also showed that
 leukocytosis [AUC: 0.938 (95%CI: 0-1.00, p:0.019)],
 neutrophil elevation [AUC: 0.938 (95%CI: 0-1.00,
 p:0.019)] and NLR [AUC: 0.917 (0-1.00 p: 0.025)]
 was found to have the power to reveal the presence
 of significant acute appendicitis.
 Conclusion
 It is recommended to use hemogram parameters and
 imaging methods effectively in the diagnosis of acute
 appendicitis in pregnants.

Analysis of risk factors for complicated appendicitis during pregnancy and evaluation of clinical prediction model: A prospective cohort study

ObjectiveTo investigate the risk factors and the value of clinical prediction model for complicated appendicitis (CA) during pregnancy. MethodsProspective analysis of pregnant patients who underwent appendectomy at a single tertiary care center between February 2020 and February 2023 and who ultimately had pathologically confirmed acute appendicitis (AA). According to intraoperative conditions and postoperative pathology, they were divided into the CA group and the uncomplicated appendicitis (UA) group. The two groups of patients were then compared in terms of demographic characteristics, disease features, ancillary tests and predictive models of acute appendicitis. ResultsA total of 90 patients with AA in pregnancy were included, 21 of whom had CA in pregnancy and 69 had UA in pregnancy. Multivariate regression analysis showed that gestational week, neutrophil ratio and C-reactive protein (CRP) were independent risk factors for CA during pregnancy. Relative to the first trimester, the third trimesters had an increased risk of complicated appendicitis (OR = 12.48, 95% CI: 1.56–99.57, P = 0.017). Neutrophil ratio ≥85.30% (OR = 24.54, 95% CI: 2.59–232.72, P = 0.005) and CRP ≥34.26 mg/L (OR = 7.86, 95% CI: 2.18–28.38, P = 0.002) had a significantly increased risk of CA. The AIR and AAS score models were statistically different between the two groups, but with a lower sensitivity of 52.38% and 42.86%, respectively. ConclusionThe third trimesters, neutrophil ratio ≥85.30% and CRP ≥34.26 mg/L may be key predictors of CA in pregnancy. The current scoring model is inadequate to identify complex appendicitis in pregnancy and further research is needed.

Clinical Characteristics of Acute Appendicitis in Pregnancy: 10-Year Experience at a Single Institution in South Korea.

Acute appendicitis is the most common cause of non-obstetric surgical disease in pregnant women. The diagnosis and treatment of appendicitis during pregnancy are very important because it can cause life-threatening morbidity to the fetus and mother. We evaluated the clinical characteristics of acute appendicitis in pregnant women. We retrospectively reviewed a medical database that included patients who underwent surgery for acute appendicitis at our hospital from January 2013 through December 2022. We compared non-pregnant women of reproductive age with pregnant women. We classified the pregnant women according to gestational age. A total of 828 patients were reproductive-aged women between 15 and 44 years old. There were 759 non-pregnant patients and 69 pregnant patients. ASA (American Society of Anesthesiologists) physical status classes were significantly higher and hospital stays were significantly longer in the pregnant group. There was no significant intergroup difference in terms of the proportions of complicated appendicitis, extended surgery, or complications. When the enrolled pregnant women were divided into three subgroups according to gestational age, the mean operation time was longest in the third-trimester subgroup. There were no differences among the subgroups in terms of the proportions of complicated appendicitis, extended surgery, or complications, nor were there differences among the subgroups in terms of laboratory findings. Preterm labor and stillbirth occurred in two pregnant women with complicated appendicitis in the second trimester. Immediate surgical treatment should be strongly considered in pregnant women with appendicitis. Efforts for more accurate diagnosis are needed for pregnant women with appendicitis.

Open versus laparoscopic appendectomy for acute appendicitis in pregnancy: a population-based study.

Laparoscopic appendectomy (LA) is the standard treatment for acute appendicitis (AA) in general population. However, the safety of LA during pregnancy has remained a matter of debate. The purpose of this study was to compare surgical and obstetrical outcomes in pregnant women who underwent LA vs. open appendectomy (OA) for AA. We hypothesized that LA results in improved surgical and obstetric outcomes during pregnancy. Using a nationwide claim-based database in Estonia, a retrospective review of all cases of pregnant women undergoing OA or LA for AA from 2010 to 2020 was performed. Patient characteristics, surgical and obstetrical outcomes were analyzed. Primary outcomes were preterm delivery, fetal loss and perinatal mortality. Secondary outcomes included operative time, hospital length of stay (HLOS) and 30-day postoperative complications. Overall, 102 patients were included of whom 68 (67%) underwent OA and 34 patients (33%) LA, respectively. Patients in LA cohort had a significantly shorter length of pregnancy in terms of gestational weeks when compared to OA cohort (12weeks versus 17weeks, p = 0.002). Most of the patients in their 3rd trimester pregnancy were subjected to OA. Operative time in LA cohort was shorter than in OA cohort (34min. versus 44min., p = 0.038). HLOS in LA cohort was shorter than in OA cohort (2.1days versus 2.9days, p = 0.016). There were no differences between OA and LA cohorts in terms of surgical complications or obstetrical outcomes. Laparoscopic appendectomy for acute appendicitis was associated with a significantly shorter operative time and a shorter hospital length of stay while open and laparoscopic appendectomy cohorts experienced comparable obstetrical outcomes. Our findings support the laparoscopic approach for acute appendicitis in pregnancy.

Complicated and uncomplicated acute appendicitis in pregnancy: a single center experience

Objectives: Acute appendicitis is the most common non-obstetric pathology requiring emergency surgery on pregnant women. The aim of the study is to show the effect of uncomplicated and complicated acute appendicitis on pregnancy. Methods: This study was conducted retrospectively at the Department of General Surgery of Konya City Hospital. Pregnant patients who underwent surgery for acute appendicitis from January 1, 2020, through December 31, 2021, were included in the study. The cases were divided into two groups as complicated and uncomplicated appendicitis and compared. The demographic, clinical, and laboratory findings of the patients were obtained by screening the patient files. The cases were divided into two groups as complicated and uncomplicated appendicitis and compared. Results: The study included 46 pregnant patients with a mean age of 25.9 years. The mean gestational age of the patients at the time of surgery was 16.5 weeks. Of the patients, 47.8% were in the first trimester. Open appendectomy was performed in 35 (76.1%) patients, and laparoscopic appendectomy in eight (17.4%). Seven (15.2%) appendicitis cases were complicated. A negative appendectomy was performed in two (4.3%) patients. Preterm labor was seen at a rate of 28.6% in the complicated appendicitis group and 5.1% in the uncomplicated appendicitis group (p = 0.04), and the mean operative times were 65.8 and 46.1 minutes, respectively (p < 0.001). Conclusions: Both postoperative complications due to surgery and obstetric complications increase in patients with complicated appendicitis; therefore, it is particularly important to closely follow up these cases.

Laparoscopic appendectomy for acute appendicitis in pregnancy

The review is devoted to the role of laparoscopic appendectomy in surgical management of acute appendicitis in pregnancy. We analyzed reviews, prospective and retrospective studies in the PubMed, Google, the Springer Link online library, the Cochrane Systematic Review databases. The results of laparoscopic and traditional treatment of acute appendicitis in pregnant women were assessed. We analyzed clinical, epidemiological features in these patients, differential diagnosis of acute appendicitis in pregnant women, indications and contraindications for endoscopic treatment, features of laparoscopic procedures. Comparative assessment of laparoscopic and open surgeries for acute appendicitis in pregnant women was carried out. We also estimated the influence of surgical treatment of acute appendicitis on subsequent course of pregnancy.

Acute appendicitis in pregnancy; A single center experience

Objective
 Appendicitis is the most common cause of extrauterine acute abdomen during pregnancy. There are scoring systems, such as Alvarado, based on physical examination and laboratory values developed for the diagnosis of appendicitis in the general population. However, when it comes to pregnant women, the effectiveness of the methods used in daily practice decreases considerably. In our study, we aimed to share the data of our patients who were diagnosed with acute appendicitis during pregnancy in our clinic.
 Material methods
 Pregnant women who were operated for acute appendicitis between April 2008 and May 2021 were included in the study. Demographic data of the patients, gestational week, physical examination and laboratory values at the time of admission, USG findings, type of surgery performed, surgical findings, pathology results and fetal-maternal complications that developed during postoperative follow -up were reviewed retrospectively through the hospital system.
 Results 
 From the clinicopathological features of the patients, only re-operation due to appendiceal stump leakage (p:0.04) and drain placement during operation (p:0.046) were significantly associated with miscarriage. Although complications and abortion rates were higher in patients with perforation and periappendicular abscess, the difference was not statistically significant.
 Conclusion
 Detailed history and physical examination are key for the diagnosis of acute appendicitis in pregnant women. Any patient with right lower quadrant pain, nausea, vomiting and fever, who has tenderness and defensive rebound in the right lower quadrant on physical examination should be considered as appendicitis after obstetric causes are excluded, until proven otherwise.

Does Acute Appendicitis in Pregnancy a Clinical Challenge in Surgery Practice? Our Experience

Objective. This study was designed to compare the diagnosis, treatment, and results of acute appendicitis in pregnant and non-pregnant women. Material and Methods. Women between the ages of 18 and 40 who were operated for acute appendicitis between 2015 and 2020 were included in the study. Results. There were 27 (3.8%) patients in Group Pregnant, and 679 (96.2%) patients in Group non-Pregnant. The mean WBC values in Group P and Group non-P was 16.53±2.91 and 13.99±4.31 (x103), and there was a significant difference between the groups.Mean pain symptom duration time was 3.40±1.90 in Group P and 1.91±1.34 day in Group non-P, while it was significantly longer in Group P . When the preoperative USG reports were evaluated, no significant difference was found between the groups.The diagnosis was made by MRI in 2 (7.4%) pregnant patients who non-visualized according to the USG report. In Group P, 10 patients were laparoscopic, 17 patients open; In group non-P, 153 patients laparoscopic and 526 patients were operated using open surgery technique. While the mean operation time did not differ significantly between the groups. Length of hospital stay was significantly higher in Group P with 3.48±4.26 days to 1.95±1.45 days. Conclusion. Diagnosis and treatment of acute appendicitis during pregnancy may be difficult, but with advanced radiological examinations and experienced surgeons, these difficulties can be easily overcome.

Spontaneous Rupture of Unscarred Uterus in Second Trimester Pregnancy Presented as Acute Appendicitis; An Unusual Obstetric Emergency and the Importance of Imaging in Suspected Acute Appendicitis in Pregnancy

Spontaneous uterine rupture in an unscarred uterus in early trimester is very rare and difficult to diagnose. We reported a case of 28 years old lady at 15th week of gestation with three previous uneventful obstetrical history presented with one-day history of acute right iliac fossa pain and vomiting. She was subjected for an open appendectomy after an assessment by obstetric and surgical team which revealed ruptured of uterine fundal. She recovered well but she lost her pregnancy. Traditional management of acute appendicitis in pregnant patients is an early exploration. However recent studies showed that it was unpractical as the rate of pregnancies loss was two times with negative appendectomy compared to simple appendicitis; and almost as high as complicated appendicitis. All suspected appendicitis cases required ultrasound studies, and when the diagnosis is uncertain, further imaging such as computed tomography (CT) scan or magnetic resonance imaging is needed prior to surgery.

Diagnostic accuracy of ultrasound in diagnosing acute appendicitis in pregnancy: a systematic review and meta-analysis.

Lack of timely diagnosis of acute appendicitis (AA) can lead to perforation and peritonitis, which might be associated with complications such as miscarriage, preterm delivery, fetal loss, and even maternal mortality. The aim of the present systematic review and meta-analysis was to evaluate the accuracy of ultrasonography (US) for diagnosing AA in pregnant patients. We performed the present systematic review and meta-analysis based on Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). Using a pre-designed standard datasheet, the two authors summarized the data of each study independently. Pregnant women with diagnosed or suspected AA, who have undergone ultrasonography, as well as using CT scan or surgery as the standard method, were included. A total of 8 studies consisting of 1593 patients were included. The main analysis showed that the overall sensitivity and specificity were 77.6% and 75.3% for US in diagnosing AA in pregnancy. The sensitivity of US in the first, second, and third trimesters of pregnancy were 69%, 63%, and 51%, respectively. While the corresponding figures for specificity were 85%, 85%, and 65%. There was a significant difference in the diagnostic performance of US between the first two trimesters and the third one. The DORs in these three trimesters were 36, 26, and 1.92, respectively. Ultrasound evaluation showed a low diagnostic accuracy for acute appendicitis in pregnant women, especially during the third trimester. These patients should be diagnosed early and accurately to prevent both complications and unnecessary operations. It can be recommended to consider alternative imaging, mostly after negative or uncertain US.

Acute appendicitis in pregnancy

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.

Acute appendicitis in pregnancy – peculiarities of diagnostic and curative management (literature review)

Abdominal pain of non-obstetriccauses is not an uncommon event during pregnancy; up to 2% of pregnant women develop an acute abdominal pathology that requires surgical treatment during gravidity, such as acute appendicitis or acute cholecystitis. Discussions on the peculiarities of the clinical presentation, diagnosis and curative management of non-obstetric pathologies in pregnant patients remain relevant. Studies in the field have shown already that surgery during gestation is safe and effective if proper precautions are followed. The consensus of several committees and professional societies is that no pregnant woman should be denied the required surgery because of pregnancy.

Single-incision Laparoscopic Appendectomy for Acute Appendicitis in Pregnancy—A Report of Two Cases—

Single-incision Laparoscopic Appendectomy for Acute Appendicitis in Pregnancy—A Report of Two Cases—

Acute Appendicitis in Pregnancy: Our Experience in Rural Area

Acute appendicitis is the most prevalent non-obstetric surgical emergency in pregnant women. The diagnosis gets more challenging when the anatomical location of the appendix shifts due to the expansion of the gravid uterus. In cases of appendicular perforation, there is a higher risk of feto-maternal morbidity and mortality, so prompt and accurate diagnosis and treatment are essential. The goal of this study is to look into the clinical signs and symptoms of acute appendicitis in pregnancy, as well as how to treat it.

Risk Factors Associated with Acute Appendicitis in Pregnancy

Backgrounds:: Acute appendicitis has been considered as the most common non-obstetric indication that requires surgical intervention in pregnant women. Objective: The aim of this study is to compare clinical manifestations and para-clinical indices between pregnant and non-pregnant patients who have undergone appendectomy. Methods:: In this prospective cohort study, 57 pregnant and non-pregnant women presenting appendicitis were compared in terms of diagnostic indicators, histopathological characteristics and laboratory findings. Results:: Periumbilical region was the point of initiation of the pain; however, it was more prominent in non-pregnant women. Similarly, tenderness in RLQ (right lower quadrant) of the abdomen was more detectable in the non-pregnant group, and some of the cases showed no rebound tenderness. Pregnant women with appendicitis presented an abnormal increase in the WBC count. Conclusion:: Pregnancy and appendicitis-related signs and symptoms have similarity among them. Due to pregnancy, the physical examination might not present an exact diagnosis; therefore, pregnant women susceptible to have appendicitis must undergo a complete and careful on-time examination that includes ultrasound and labs.