Results of Pregnant Patients Operated Due to Acute Appendicitis: Single-Center Experience of 37 Case Series

Öz

Background: Acute appendicitis is the most common nonobstetric cause of acute abdomen in pregnant women. In this study, we aimed to evaluate pregnant patients who were operated on for acute appen-dicitis in our center, which has a large pregnant population, in the light of the literature. Materials and Methods: The data of patients operated on for acute appendicitis between November 2015 and August 2022 were retrospectively examined and recorded electronically. The patients' comp-laints, physical examination findings, radiological data, operation type, and pathological data were recorded and examined in the light of the literature. Results: The average age of 37 patients who underwent appendectomy was 27.7 (20-42) years. In these patients, acute appendicitis was diagnosed most frequently in the 2nd trimester (48.6%). The most common presenting complaint of the patients was abdominal pain, and the most common physical examination finding was abdominal tenderness. Considering the admission time of the patients, it was observed that a delay of more than 24 hours increased the risk of perforation. Although the most com-mon histopathological finding was acute appendicitis, malignancy was detected in one patient and enterobius vermicularis was detected in another. Conclusions: Acute appendicitis should be kept in mind in patients with new-onset right lower quad-rant abdominal pain during pregnancy. Because delay in diagnosis and therefore surgery causes serious morbidity and mortality for both the fetus and the mother. Key Words: Appendicitis, Pregnant, Laparoscopy, Appendectomy

Akut Apandisit Nedeniyle Opere Edilen Gebe Hastaların Sonuçları: 37 Vaka Serisinin Tek Merkez Deneyimi

Öz

Amaç: Akut apandisit, gebelerde en sık görülen nonobstetrik akut batın sebebidir. Bu çalışmada geniş bir gebe volümüne sahip olan merkezimizde akut apandisit sebebiyle opere edilen gebe hastaları literatür eşliğinde değerlendirmeyi amaçladık. Materyal Ve Metod: Kasım 2015-ağustos 2022 tarihleri arasında akut apandisit nedeniyle opere edilen hastaların verileri retrospektif olarak incelenerek elektronik ortamda kayıt altına alındı. Hastaların geliş şikayetleri, fizik muayene bulguları, radyolojik tahlilleri, operasyon tipi, patolojik verileri kaydedilerek literatür eşliğinde incelendi. Bulgular: Opere edilen 37 hastanın yaş ortalaması 27,7 (20-42) idi. En sık 2. trimesterde (%48,6) akut apandisit tanısı konuldu. Hastaların en sık başvuru şikayeti karın ağrısı iken en sık fizik muayene bulgusu karında hassasiyet idi. 24 saatten fazla gecikme perforasyon riskini arttırıyor. Histopatolojik en sık görülen bulgu akut apandisit oldu. Bir hastada malignite, bir hastada ise enterobius vermicularis tespit edildi. Sonuç: Gebe iken karın ağrısı olan hastalarda akut apandisit akılda tutulmalıdır. Zira tanının dolayısıyla ameliyatın gecikmesi hem fetal hem maternal ciddi morbidite ve mortaliteye sebep olmaktadır.

Anahtar Kelimeler

• laparoskopi
• appendektomi
• apandisit
• gebe

Kaynakça

1. 1. Arer İM, Alemdaroğlu S, Yeşilağaç H, Yabanoğlu H. Gebe-likte akut apandisit: 20 hamile kadın olgu çalışması. Ulus Travma ve Acil Cerrahi Derg. 2016;22(6):545–8.
2. 2. Andersen B, Nielsen TF. Appendicitis in pregnancy: Diagno-sis, management and complications. Acta Obstet Gynecol Scand. 1999;78(9):758–62.
3. 3. Andersson REB, Lambe M. Incidence of appendicitis during pregnancy. Int J Epidemiol. 2001;30(6):1281–5.
4. 4. Lee SH, Lee JY, Choi YY, Lee JG. Laparoscopic appendec-tomy versus open appendectomy for suspected appendici-tis during pregnancy: A systematic review and updated me-ta-analysis. BMC Surg. 2019;19(1):1–12.
5. 5. Tatli F, Yucel Y, Gozeneli O, Dirican A, Uzunkoy A, Yalçın HC, et al. The Alvarado Score is accurate in pregnancy: a retrospective case–control study. European Journal of Tra-uma and Emergency Surgery. 2019; 45:411–6.
6. 6. Abbasi N, Patenaude V, Abenhaim H. Management and outcomes of acute appendicitis in pregnancy-population-based study of over 7000 cases. BJOG An Int J Obstet Gynaecol. 2014;121(12):1509–14.
7. 7. Yilmaz HG, Akgun Y, Bac B, Celik Y. Acute appendicitis in pregnancy - risk factors associated with principal outco-mes: A case control study. Int J Surg. 2007;5(3):192–7.
8. 8. Baruch Y, Canetti M, Blecher Y, Yogev Y, Grisaru D, Mic-haan N. The diagnostic accuracy of ultrasound in the diag-nosis of acute appendicitis in pregnancy. J Matern Neona-tal Med. 2020;33(23):3929–34.

9. 9. Akbulut S, Koç C, Şahin TT, Şahin E, Tuncer A, Demyati K, vd. An investigation into the factors predicting acute ap-pendicitis and perforated appendicitis. Ulus Travma ve Acil Cerrahi Derg. 2021;27(4):434–42.
10. 10. Ardeshir Babaknia MD, Hossein Parsa MD JDWM. Appendi-citis During Pregnancy. Obstetrics and Gynecology. 1977;50(1): 40-44.
11. 11. Çınar H, Aygün A, Derebey M, Tarım İA, Akalın, Büyükakın-cak S, vd. Significance of hemogram on diagnosis of acute appendicitis during pregnancy. Ulusal Travma ve Acil Cer-rahi Dergisi. 2018;24(5):423–8.
12. 12. Jung SJ, Lee DK, Kim JH, Kong PS, Kim KH, Bae SW. Appen-dicitis during Pregnancy: The Clinical Experience of a Se-condary Hospital. J Korean Soc Coloproctol. 2012 Jun;28(3):152-9. doi: 10.3393/jksc.2012.28.3.152.
13. 13. Haksal MC, Turgut HT. Gebelerde akut apandisit : klinik deneyimimiz Acute appendicitis during pregnancy : Clinical Experience. Medical Journal of Kocaeli 2014;1:1-5
14. 14. Long SS, Long C, Lai H, Macura KJ. Imaging strategies for right lower quadrant pain in pregnancy. Am J Roentgenol. 2011;196(1):4–12.
15. 15. Zheng M, Li T, Li Y, Zhang T, Zhang L, Ma W, et al. Survival Profile and Prognostic Factors for Appendiceal Mixed Neu-roendocrine Non-neuroendocrine Neoplasms: A SEER Popu-lation-Based Study. Front Oncol. 2020;10(8):1–10.
16. 16. Bickell NA, Aufses AH, Rojas M, Bodian C. How time af-fects the risk of rupture in appendicitis. J Am Coll Surg. 2006;202(3):401–6.
17. 17. Al-Qudah MS, Amr M, Sroujieh A, Issa A. Appendectomy in pregnancy: The experience of a university hospital. J Obstet Gynaecol (Lahore). 1999;19(4):362–4.
18. 18. Carmelita A. Wallace&Maxim S. Petrov&David I. Soy-bel&Stephen J. Ferzoco&Stanley W. Ashley&Ali Tavakkoli-zadeh. Influence of Imaging on the Negative Appendec-tomy Rate in Pregnancy. J Gastrointest Surg. 2008;12:16–50.
19. 19. McGory ML, Zingmond DS, Tillou A, Hiatt JR, Ko CY, Cryer HM. Negative Appendectomy in Pregnant Women Is Asso-ciated with a Substantial Risk of Fetal Loss. J Am Coll Surg. 2007;205(4):534–40.
20. 20. Tanga MR, De Maio F, Ewing JB. Acute Appendicitis in Pregnancy. J Asian Fed Obstet Gynaecol. 1973;4(1):35–8.
21. 21. Popkin CA, Lopez PP, Cohn SM, Brown M, Lynn M. The incision of choice for pregnant women with appendicitis is through McBurney’s point. Am J Surg. 2002;183(1):20–2.
22. 22. House JB, Bourne CL, Seymour HM, Brewer KL. Location of the appendix in the gravid patient. J Emerg Med. 2014;46(5):741–4.
23. 23. Prodromidou A, Machairas N, Kostakis ID, Molmenti E, Spartalis E, Kakkos A, et al. Outcomes after open and lapa-roscopic appendectomy during pregnancy: A meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2018;225:40–50.
24. 24. Haya AF, Togas T. Safety and risk of laparoscopy in preg-nancy. Curr Opin Obstet Gynecol. 2002;14:375–9.