Vol 88, No 3 (2017)
Research paper
Published online: 2017-03-31

open access

Page views 1698
Article views/downloads 2003
Get Citation

Connect on Social Media

Connect on Social Media

Outcomes of the patients diagnosed incidentally appendicitis during cesarean section

Mehmet Kulhan, Nur Gozde Kulhan, Umit Nayki, Cenk Nayki, Pasa Ulug, Nahit Ata, Hulya Toklucu
Pubmed: 28397204
Ginekol Pol 2017;88(3):147-150.

Abstract

Objectives: Appendicitis is the most common condition leading to an intraabdominal operation for a non obstetric problem in pregnancy and diagnosis of appendicitis is complicated by the physiologic and anatomic changes that occur during pregnancy. Although a surgical procedure carries the risk of fetal loss or preterm delivery, delay in diagnosis also increases the risk of complications in both mother and fetus. In this report we present our experience and analyze clinical characteristic and the pregnancy outcomes of appendicitis diagnosed incidentally during cesarean in the third trimester.

Material and methods: The study population consisted of 23 pregnant women who were diagnosed incidentally with appendicitis during cesarean at Erzincan University Hospital between 2015 and 2016.

Results: Appendectomy was performed on 23 patients during a caesarean section performed for any reason. The mean dia-meter of appendix was 7.82 ± 1.85 mm. The mean operation time was 67.39 ± 18.94 SD and antibiotic therapy was given to all patients. Postoperative complications were noted in 4 (17.4%) patients. Wound infection was seen in 4 (17.4%) patients, the other 19 patients revealed no postoperative complications. The mean of APGAR score of newborns in the postoperative period was 8.26 ± 0.86 SD and no complications were observed in both mothers and newborns. Histopathology of the specimen confirmed acute appendicitis in 23 (100%) cases.

Conclusions: Acute appendicitis is a challenging diagnosis in the pregnant patient; however, early surgical intervention should be performed with any suspicion. The type of surgery depends on the surgeon’s preference and experience.

References

  1. Stukan M, Kruszewski WJ, Dudziak M, et al. Appendicitis and gall bladder diseases as acute abdominal conditions in pregnancy. Ginekol Pol. 2013; 84(12): 1045–1050.
  2. Bickell NA, Aufses AH, Rojas M, et al. How time affects the risk of rupture in appendicitis. J Am Coll Surg. 2006; 202(3): 401–406.
  3. Shambe IH, Dikkol N, Ozoilo KN. Pregnancy outcome following non-obstetric abdominal surgery in Jos University Teaching Hospital: A 5-year retrospective study. Niger J Clin Pract. 2016; 19(5): 591–594.
  4. Terzi A, Yildiz F, Vural M, et al. A case series of 46 appendectomies during pregnancy. Wiener klinische Wochenschrift. 2010; 122(23-24): 686–690.
  5. Maslovitz S, Gutman G, Lessing JB, et al. The significance of clinical signs and blood indices for the diagnosis of appendicitis during pregnancy. Gynecol Obstet Invest. 2003; 56(4): 188–191.
  6. Barber-Millet S, Bueno Lledó J, Granero Castro P, et al. Update on the management of non-obstetric acute abdomen in pregnant patients. Cir Esp. 2016; 94(5): 257–265.
  7. Viktrup L, Hée P. Fertility and long-term complications four to nine years after appendectomy during pregnancy. Acta Obstet Gynecol Scand. 1998; 77(7): 746–750.
  8. Choi JJ, Mustafa R, Lynn ET, et al. Appendectomy during pregnancy: follow-up of progeny. J Am Coll Surg. 2011; 213(5): 627–632.
  9. Bouyou J, Gaujoux S, Marcellin L, et al. Abdominal emergencies during pregnancy. J Visc Surg. 2015; 152(6 Suppl): S105–S115.
  10. Kilpatrick CC, Monga M. Approach to the acute abdomen in pregnancy. Obstet Gynecol Clin North Am. 2007; 34(3): 389–402, x.
  11. Mourad J, Elliott JP, Erickson L, et al. Appendicitis in pregnancy: new information that contradicts long-held clinical beliefs. Am J Obstet Gynecol. 2000; 182(5): 1027–1029.
  12. Brown JJS, Wilson C, Coleman S, et al. Appendicitis in pregnancy: an ongoing diagnostic dilemma. Colorectal Dis. 2009; 11(2): 116–122.
  13. Young BC, Hamar BD, Levine D, et al. Medical management of ruptured appendicitis in pregnancy. Obstet Gynecol. 2009; 114(2 Pt 2): 453–456.
  14. Silvestri MT, Pettker CM, Brousseau EC, et al. Morbidity of appendectomy and cholecystectomy in pregnant and nonpregnant women. Obstet Gynecol. 2011; 118(6): 1261–1270.
  15. Babaknia A, Parsa H, Woodruff JD. Appendicitis during pregnancy. Obstet Gynecol. 1977; 50(1): 40–44.
  16. McGory ML, Zingmond DS, Tillou A, et al. Negative appendectomy in pregnant women is associated with a substantial risk of fetal loss. J Am Coll Surg. 2007; 205(4): 534–540.