Elsevier

The Surgeon

Volume 12, Issue 2, April 2014, Pages 82-86
The Surgeon

Review
Suspected appendicitis in pregnancy

https://doi.org/10.1016/j.surge.2013.11.022Get rights and content

Abstract

Aim

Acute appendicitis is one of the most common acute surgical presentations. However investigation and management is sometimes confounded in a pregnant patient. Appendicitis in pregnancy is often managed jointly by both the surgical and obstetric teams, which can lead to discrepant pathways, which may be detrimental to the patient.

This review sets out to identify the normal physiological changes of pregnancy that pose diagnostic and therapeutic difficulties to the clinician, assess the more common differential diagnoses and review the current evidence to assist achieving a swift diagnosis and appropriate treatment.

Methods

A literature review of the investigation and management of suspected appendicitis in pregnancy was undertaken. Guidelines by the relevant surgical, obstetric and radiological societies were also reviewed.

Results

There remains no consensus on the best diagnostic pathway for appendicitis in pregnancy; which is unsurprising given that appendicitis in non-pregnant patients can yield diagnostic conundrums. However this review identifies a role for MRI scanning as a useful adjunct in these patients. The increasing role of laparoscopy in these patients is also becoming more apparent.

Conclusion

Appendicitis in pregnancy remains a complex problem necessitating a close working relationship between various specialties to achieve the best outcome for mother and fetus.

Introduction

Acute abdominal pain in pregnancy presents a diagnostic and therapeutic challenge to the clinician. A serious cause of acute abdominal pain in pregnancy is an acute appendicitis.1 These patients are often managed jointly by surgical and obstetric teams. However, depending on service provision they are usually admitted under a parent team which could either be surgical or obstetric; leading to discrepant investigative and management pathways.

The aim of this paper is to review the current literature on appendicitis during pregnancy and discuss investigative and management strategies.

Section snippets

Background

Acute appendicitis is seen in approximately 1 in 1700 pregnancies; and is most common in the second trimester of pregnancy.2, 3 Appendicectomy is the commonest non obstetric operation performed during pregnancy.4 Prompt diagnosis and appropriate management of acute appendicitis in pregnancy is vital to reduce the potential risks to both mother and fetus.

Conclusion

Acute appendicitis in pregnancy poses risks to both the mother and fetus. It is imperative that as clinicians we promptly diagnose and treat these patients to prevent adverse outcomes. The challenges presented by the anatomy and physiology of pregnancy can lead to delays in diagnosis and treatment. Delay in diagnosis of acute appendicitis can lead to perforation and worse outcomes. Radiological imaging can provide useful information for the clinician to help diagnosis. This review highlights

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