Skip to main content

Advertisement

SpringerLink
Log in

Acute Appendicitis During Pregnancy: Different from the Nonpregnant State?

  • Original Scientific Report
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

Acute appendicitis is the most common nonobstetric indication for surgical intervention during pregnancy. However, the current literature is scarce and composed of relatively small case series. We aimed to compare the presentation, management, and surgical outcomes of presumed acute appendicitis between a contemporary cohort of pregnant women and nonpregnant women of reproductive age.

Methods

The study group included 92 pregnant patients who underwent appendectomy for presumed acute appendicitis at a single tertiary medical center in 2000–2014. Preoperative, operative, and postoperative clinical data were derived from medical records and compared to data for 494 nonpregnant patients of reproductive age who underwent appendectomy in 2004–2007 at the same institution.

Results

Median age was 28 years (range 25–33) in the study group and 26 years (range 20–34) in the control group (P = 0.1). There were no between-group differences in mean white blood cell count, patient interval, hospital interval, or operative time. Preoperative abdominal ultrasound was used in a significantly higher proportion of patients in the pregnant group than in the nonpregnant group (73 and 27 %, respectively, P < 0.001) and computed tomography, in a significantly lower proportion of patients (1 vs. 16 %, respectively, P < 0.001) . The two groups had similar rates of negative appendectomy (23 and 22 %, P = 0.9), complicated appendicitis (12 and 11 %, P = 0.9), and overall postoperative complications (15 and 12 %, P = 0.3).

Conclusions

The clinical presentation and outcome of presumed acute appendicitis are similar in pregnant women and nonpregnant women of reproductive age. Therefore, similar perioperative management algorithms may be applied in both patient populations.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Kort B, Katz VL, Watson WJ (1993) The effect of nonobstetric operation during pregnancy. Surg Gynecol Obstet 177:371–376

    CAS  PubMed  Google Scholar 

  2. Guttman R, Goldman RD, Koren G (2004) Appendicitis during pregnancy. Can Fam Phys Medecin de Famille Canadien 50:355–357

    Google Scholar 

  3. Franca Neto AH, Amorim MM (1992) Nobrega BM Acute appendicitis in pregnancy: literature review. Rev Assoc Med Bras 2015(61):170–177

    Google Scholar 

  4. Woodfield CA, Lazarus E, Chen KC et al (2010) pain in pregnancy: diagnoses and imaging unique to pregnancy–review. AJR Am J Roentgenol 194:Ws14–Ws30

    Article  PubMed  Google Scholar 

  5. Branch DW (1992) Physiologic adaptations of pregnancy. Am J Reprod Immunol (New York, 1989) 28: 120–122

  6. Andersen B, Nielsen TF (1999) Appendicitis in pregnancy: diagnosis, management and complications. Acta Obstet Gynecol Scand 78:758–762

    Article  CAS  PubMed  Google Scholar 

  7. American Congress of Obstetricians and Gynecologists (ACOG) Guidelines for diagnostic imaging during pregnancy and lactation. http://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Obstetric-Practice/Guidelines-for-Diagnostic-Imaging-During-Pregnancy. Accessed Feb 2016

  8. Al-Qudah MS, Amr M, Sroujieh A et al (1999) Appendectomy in pregnancy: the experience of a university hospital. J Obstet Gynaecol: J Inst Obstet Gynaecol 19:362–364

    Article  CAS  Google Scholar 

  9. Bickell NA, Aufses AH Jr, Rojas M et al (2006) How time affects the risk of rupture in appendicitis. J Am Coll Surg 202:401–406

    Article  PubMed  Google Scholar 

  10. Reproductive Health Indicators (2006) Guidelines for their generation, interpretation and analysis for global monitoring. World Health Organization 2006. Geneva: WHO Press

  11. Segev L, Keidar A, Schrier I et al (2015) Acute appendicitis in the elderly in the twenty-first century. J Gastrointest Surg 19:730–735

    Article  PubMed  Google Scholar 

  12. Vinay Kumar M, Abbas AK, Aster JC (2015) Robbins and cotran pathologic basis of disease, 9th edn. Elsevier Health Sciences

    Google Scholar 

  13. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213

    Article  PubMed  PubMed Central  Google Scholar 

  14. Sadot E, Wasserberg N, Shapiro R et al (2013) Acute appendicitis in the twenty-first century: should we modify the management protocol? J Gastrointest Surg 17:1462–1470

    Article  PubMed  Google Scholar 

  15. Maslovitz S, Gutman G, Lessing JB et al (2003) The significance of clinical signs and blood indices for the diagnosis of appendicitis during pregnancy. Gynecol Obstet Investig 56:188–191

    Article  Google Scholar 

  16. Horowitz MD, Gomez GA, Santiesteban R et al (1985) Acute appendicitis during pregnancy. Diagnosis and management. Arch Surg 120:1362–1367

    Article  CAS  PubMed  Google Scholar 

  17. Stone K (2002) Acute abdominal emergencies associated with pregnancy. Clin Obstet Gynecol 45:553–561

    Article  PubMed  Google Scholar 

  18. Sharp HT (2002) The acute abdomen during pregnancy. Clin Obstet Gynecol 45:405–413

    Article  PubMed  Google Scholar 

  19. McGory ML, Zingmond DS, Tillou A et al (2007) Negative appendectomy in pregnant women is associated with a substantial risk of fetal loss. J Am Coll Surg 205:534–540

    Article  PubMed  Google Scholar 

  20. Ito K, Ito H, Whang EE et al (2012) Appendectomy in pregnancy: evaluation of the risks of a negative appendectomy. Am J Surg 203:145–150

    Article  PubMed  Google Scholar 

  21. Kuvin SF, Brecher G (1962) Differential neutrophil counts in pregnancy. N Engl J Med 266:877–878

    Article  CAS  PubMed  Google Scholar 

  22. Hiersch L, Yogev Y, Ashwal E et al (2014) The impact of pregnancy on the accuracy and delay in diagnosis of acute appendicitis. J Matern-fetal Neonat Med 27:1357–1360

    Article  Google Scholar 

  23. Wang PI, Chong ST, Kielar AZ et al (2012) Imaging of pregnant and lactating patients: part 2, evidence-based review and recommendations. AJR Am J Roentgenol 198:785–792

    Article  PubMed  Google Scholar 

  24. Wallace CA, Petrov MS, Soybel DI et al (2008) Influence of imaging on the negative appendectomy rate in pregnancy. J Gastrointest Surg 12:46–50

    Article  PubMed  Google Scholar 

  25. Terzi A, Yildiz F, Vural M et al (2010) A case series of 46 appendectomies during pregnancy. Wien Klin Wochenschr 122:686–690

    Article  PubMed  Google Scholar 

  26. Mazze RI, Kallen B (1991) Appendectomy during pregnancy: a Swedish registry study of 778 cases. Obstet Gynecol 77:835–840

    CAS  PubMed  Google Scholar 

  27. Agholor K, Omo-Aghoja L, Okonofua F (2011) Rate of negative appendectomy in pregnant women in Benin City, Nigeria. J Obstet Gynaecol Res 37:1540–1548

    Article  PubMed  Google Scholar 

  28. Weingold AB (1983) Appendicitis in pregnancy. Clin Obstet Gynecol 26:801–809

    Article  CAS  PubMed  Google Scholar 

  29. MacDorman MF, Gregory EC (2015) Fetal and perinatal mortality: United States, 2013. Natl Vital Stat Rep 64:1–24

    Google Scholar 

  30. Martin JA, Hamilton BE, Osterman MJ et al (2015) Births: final data for 2013. Natl Vital Stat Rep 64:1–65

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of General and Oncological Surgery – Surgery C, Sheba Medical Center, Tel Hashomer, 5262100, Ramat Gan, Israel

    L. Segev, S. Rayman & A. Nissan

  2. Department of Obstetrics and Gynecology, Carmel Medical Center, Haifa, Israel

    Y. Segev

  3. Division of Surgical Oncology, Department of Surgery, Rabin Medical Center, Petah Tikva, Israel

    E. Sadot

  4. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel

    L. Segev, S. Rayman, A. Nissan & E. Sadot

  5. Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel

    Y. Segev

Authors
  1. L. Segev
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Y. Segev
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. S. Rayman
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. Nissan
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. E. Sadot
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to L. Segev.

Ethics declarations

Conflict of interest

None.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Segev, L., Segev, Y., Rayman, S. et al. Acute Appendicitis During Pregnancy: Different from the Nonpregnant State?. World J Surg 41, 75–81 (2017). https://doi.org/10.1007/s00268-016-3731-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-016-3731-7

Keywords

Search

Navigation