Acute appendicitis in pregnancy

Yıl 2010, Cilt: 37 Sayı: 2, 134 - 139, 01.06.2010

Mehmet Ali Yağcı Atakan Sezer Ahmet Rahmi Hatipoğlu İrfan Coşkun Zeki Hoşcoşkun

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

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