Impact of appendicitis during pregnancy: No delay in accurate diagnosis and treatment

• Ultrasonography has a high rate of non-visualization of the appendix.
• (Perforated) appendicitis is known to be associated with a high rate of maternal and fetal morbidity and mortality.
• Prematurity was seen following a negative appendectomy (33%) and perforated appendicitis (33%).
• A rapid and accurate diagnosis of appendicitis is particularly critical in pregnant patients.
• We recommend clinicians to consider an MRI to improve diagnostic accuracy to reduce the rate of negative appendectomies.

BackgroundAcute appendicitis during pregnancy may be associated with serious maternal and/or fetal complications. To date, the optimal clinical approach to the management of pregnant women suspected of having acute appendicitis is subject to debate. The purpose of this retrospective study was to provide recommendations for prospective clinical management of pregnant patients with suspected appendicitis.MethodCase records of all pregnant patients suspected of having appendicitis whom underwent appendectomy at our hospital between 1990 and 2010 were reviewed.ResultsAppendicitis was histologically verified in fifteen of twenty-one pregnant women, of whom six were diagnosed with perforated appendicitis. Maternal morbidity was seen in two cases. Premature delivery occurred in two out of six cases with perforated appendicitis cases and two out of six cases following a negative appendectomy. Perinatal mortality did not occur.ConclusionBoth (perforated) appendicitis and negative appendectomy during pregnancy are associated with a high risk of premature delivery. Clinical presentation and imaging remains vital in deciding whether surgical intervention is indicated. We recommend to cautiously weigh the risks of delay until correct diagnosis with associated increased risk of appendiceal perforation and the risk of unnecessary surgical intervention. Based upon current literature, we recommend clinicians to consider an MRI following an inconclusive or negative abdominal ultrasound aiming to improve diagnostic accuracy to reduce the rate of negative appendectomies. Accurate and prompt diagnosis of acute appendicitis should be strived for to avoid unnecessary exploration and to aim for timely surgical intervention in pregnant women suspected of having appendicitis.