Appendicitis in pregnancy: a novel approach for diagnostic dilemma

Background: The preoperative diagnosis of acute appendicitis is often inaccurate in 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 regardless of gestational age. Fever and leucocytosis are not clear indicators of appendicitis in pregnancy.

DOI: http://dx.doi.org/10.4038/sljog.v34i1.4815

Sri Lanka Journal of Obstetrics and Gynaecology 2012; 34: 6-10