Acute appendicitis in pregnancy

Öz

Objective: The aim of the study is to evaluate the diag­nosis methods and treatment options of pregnant acute appendicitis among the patients who admitted to general surgery clinic. Patients and Methods: Seven cases were diagnosed as acute appendicitis and underwent appendectomy dur­ing pregnancy, were evaluated between January 2002 and December 2009. All patients had preoperative ultra­sonography and laboratory examination. Fetal heart rate and viability were followed with ultrasonography in preop­erative period. Results: Five patients (71.4%) were in 3. trimester, one patient (14.2%) was in 2. and one patient (14.2%) was in first trimester in admission. All patients had abdominal tenderness and the patients were preoperatively diag­nosed as acute appendicitis by ultrasonography exami­nation. Seven patients underwent appendectomy. Three of seven (42.8%) were acute appendicitis, three were per­forated appendicitis, and one patient had the appendix without any pathology. There was a periceacal abscess formation in one patient and two patients had localized peritonitis among the three perforated appendicitis pa­tients. The mean postoperative hospital stay was 5.1 days. No maternal or fetal mortality were observed. Conclusion: The delay in the diagnosis and the pres­ence of different clinic signs of acute appendicitis due to physiologic changes during pregnancy leads to maternal and fetal morbidity and mortality. We believe that quick, rational, and multidisciplinary approach in diagnosis and treatment period of pregnant women suspected with acute appendicitis may reduce both maternal and fetal morbid­ity and mortality.

Anahtar Kelimeler

• Pregnancy, acute appendicitis, surgical treat­ment

Gebelikte akut apandisit

Öz

Amaç: Bu çalışmanın amacı genel cerrahi kliniğimize başvuran vakalar doğrultusunda gebelik esnasında görü­lebilecek akut apandisitin tanı ve tedavisini irdelemektir. Hastalar ve Yöntemler: Ocak 2002-Aralık 2009 yılları arasında gebeliği döneminde apandisit ön tanısı ile ap­pendektomi yapılan yedi gebe olgu geriye dönüşlü ola­rak incelenmiştir. Hastaların rutin peroperatif tetkikleri ve karın ultrasonografileri yapıldı. Preoperatif dönemde fetal kalp atımı izlendi ve fetüsün canlılığı ultrasonografi ile ta­kip edildi. Bulgular: Başvuru anında olguların beşi (%71.4) 3. tri­mester, biri (%14.2) 2. trimester ve bir diğeri (%14.2) 1. trimesterde idi. Tüm hastaların karın muayenelerinde hassasiyet mevcuttu ve ultrasonografi incelemesinde akut apandisit ile uyumlu bulgular saptandı. Yedi hasta­ya appendektomi yapıldı. Üçünde (%42,8) akut apandisit, üçünde (%42.8) perfore apandisit, bir (%14.2) hastada apendiks normal olarak gözlendi. Perfore olguların birin­de periçekal apse formasyonu, diğer ikisinde lokalize pe­ritonit mevcuttu. Hastaların postoperatif hastanede kalış zamanı ortalama 5.1 gün idi. Postoperatif anne ve bebek ölümü gözlenmedi. Sonuç: Gebelikle meydana gelen fizyolojik değişiklikler nedeniyle akut apandisitin tanı gecikmesi ve farklı klinik semptomların olması anne ve fetüs için morbidite ve mor­talite oluşturur. Akut apandisit şüphesi bulunan gebe ka­dınlarda hızlı, akılcı ve multidisipliner yaklaşım ile gerek maternal gerekse fetal morbidite ve mortalitenin en aza indirilebileceği kanısındayız.

Anahtar Kelimeler

• Gebelik, akut apandisit, cerrahi teda­vi

Kaynakça

1. Zhang Y, Zhao YY, Qiao J, Ye RH. Diagnosis of appendicitis during pregnancy and perinatal outcome in the late preg- nancy. Chin Med J (Engl) 2009;122:521-4.
2. Basaran A, Basaran M. Diagnosis of acute appendicitis dur- ing pregnancy: a systematic review. Obstet Gynecol Surv. 2009; 64:481-8.
3. Mourad J, Elliott JP, Erickson L, Lisboa L. Appendicitis in pregnancy: new information that contradicts long-held clin- ical beliefs. Am J Obstet Gynecol 2000;182:1027-9.
4. Hee P, Viktrup L. The diagnosis of appendicitis during preg- nancy and maternal and fetal outcome after appendectomy. Int J Gynaecol Obstet 1999;65:129-35.
5. Tracey M, Fletcher HS. Appendicitis in pregnancy. Am Surg 2000; 66:555-9.
6. Tamir IL, Bongard FS, Klein SR. Acute appendicitis in the pregnant patient. Am J Surg 1990;160:571-6.
7. Ueberrueck T, Koch A, Meyer L, Hinkel M, Gastinger I. Ninety-four appendectomies for suspected acute appendici- tis during pregnancy. World J Surg 2004;28:508-11.
8. Al-Mulhim AA. Acute appendicitis in pregnancy. A review of 52 cases. Int Surg 1996;81:295-7.

9. Atilla K, Uçar AD, Ünek T, Sevinç A, Çevik AA, Sök- men S. Gebelikte Akut apandisit. Ulusal Travma Dergisi 2002;8:98-101.
10. Pastore PA, Loomis DM, Sauret J. Appendicitis in preg- nancy. J Am Board Fam Med 2006;19:621-6.
11. Nathan L, Huddleston JF. Acute abdominal pain in preg- nancy. Obstet Gynecol Clin North Am 1995;22: 55-68.
12. Coleman MT, Trianfo VA, Rund DA. Nonobstetric emer- gencies in pregnancy: trauma and surgical conditions. Am J Obstet Gynecol 1997;177:497-502.
13. Baer JL, Reis RA, Arens RA: Appendicitis in pregnancy. J Am Med Assoc 1932;98:1359-64.
14. Eryılmaz R, Şahin M, Baş G, Alimoğlu O. Acute appendici- tis during pregnancy. Digestive Surgery 2002;19:40-4.
15. Cunningham FG, McCubbin JH. Appendicitis complicating pregnancy. Obstet Gynecol 1969;9:94-99.
16. Sharp HT. Gastrointestinal surgical conditions during preg- nancy. Clin Obstet Gynecol 1994;37:306-15.
17. Hauptmann J, Mechtersheimer G, Bläker H, Schaupp W, Otto HF. Deciduosis of the appendix: differential diagnosis of acute appendicitis. Chirurg 2000;71: 89-92.
18. Schmidt-Matthiesen A, Schmidt-Matthiesen H. Acute dis- order of the lower abdomen: how to differentiate between gynaecological and surgical causes. Geburtshilfe Frauen- heilkd 1993;53:754-9
19. Lim HK, Bae SH, Seo GS. Diagnosis of acute appendicitis in pregnant women: value of sonography. AJR 1992;159:539- 42.
20. Adalı F, Adalı E. Gebelikte Tanısal Görüntüleme Yöntem- lerinin Fetusa Etkisi. Van Tıp Dergisi 2008;15:64-9.
21. Old J, Dusing R, Yap W, Dirks J. Imaging for Suspected Appendicitis. Am Fam Phys 2005;71:71-8.
22. Ames Castro M, Ship TD, Castro EE, Ouzounian J, Rao P. The use of helical computed tomography in pregnancy for the diagnosis of acute appendicitis. Am J Obstet Gynecol. 2001;184:954-7.
23. Danso D, Dimitry ES. Perforated 26 weeks pregnant uterus at appendicectomy. BJOG 2004;111:628 -9.
24. Machado NO, Grant CS. Laparoscopic appendicectomy in all trimesters of pregnancy. JSLS 2009;13:384-90.
25. Kirshtein B, Perry ZH, Avinoach E, Mizrahi S, Lantsberg L. Safety of laparoscopic appendectomy during pregnancy. World J Surg 2009;33:475-80.
26. Walsh CA, Walsh SR. Laparoscopic appendectomy dur- ing pregnancy: an evidence- based review. Surg Endosc 2009;23:671-9.