Georges Abizeid, Hager Aref, Obada Alhallak. International Medical Center
Introduction: Acute appendicitis (AA) is the most common general surgical problem encountered during pregnancy, affecting 1 in 500 to 1 in 2000 pregnancies. Emergency Department, General Surgery, and Obstetric physicians. will face this challenging situation of abdominal pain in a pregnant woman suspected of AA.especially in diagnosis, management, and surgical approach.
Objectives: First, to report our experience of operated pregnant patients for AA; Second, to propose an algorithm to facilitate the optimal management. Third, to suggest strongly, after analysis of the results of this series and review of literature that Laparoscopic appendectomy (LA) is considered as the “new standard of care”.
Methods: Between November 2013 and January 2018, seventeen patients diagnosed with AA, who underwent LA (N=17) were included in this study. Data collection and details were reviewed retrospectively based on medical records.
Results: Retrospective analysis of 17 consecutive cases of suspected AA during pregnancy was carried out. (Nov. 2013 – January 2018). Patients were in their first (35%), second (53%) and third trimesters (12%). The average gestational age was 17.5 weeks [5-27]. All patients had preoperative Ultrasound with (54%) accuracy, non-conclusive in 7 cases. MRI done for six of these seven patients confirmed the diagnosis of AA.in 5 patients (84%). All patients were operated laparoscopically, no conversion done. Negative appendectomy rate was (6%). Postoperative complications were (6%) with paralytic ileus treated conservatively. No obstetrical or fetal complications found. No differences were observed between trimesters in terms of clinical presentation and outcome except for operative technical modifications.
Conclusion: Acute appendicitis in pregnancy is a clinically challenging situation that often cannot be faced without the aid of radiological investigations. Ultrasound and Magnetic Resonance Imaging may help to avoid late diagnosis and contribute to decreasing the rate of negative appendectomy. Operating with no delay will reduce the appendicular perforation and the feto-maternal complications. Laparoscopic appendectomy in pregnancy is the standard of care, regardless of the trimester.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 91995
Program Number: P013
Presentation Session: Poster Session (Non CME)
Presentation Type: Poster