Acute appendicitis during pregnancy. Diagnosis and management
M. D. Horowitz, G. A. Gomez, R. Santiesteban and G. Burkett
Twelve patients underwent appendectomy during pregnancy or in the
puerperium. The clinical presentation of acute appendicitis is altered
during gestation, and diagnosis becomes increasingly difficult when close
to term. Abdominal pain, nausea, and vomiting are important symptoms.
Peritoneal signs occur in the right lower quadrant early in pregnancy, but
the upper quadrant or entire right side are more common locations, as the
appendix is displaced upward by the enlarging uterus. Delay in treatment is
common because of uncertainty in making the diagnosis and hesitancy to
proceed with surgery. In the group of six patients with perforation, there
was one maternal death and a loss of three fetuses. There were no
complications in the absence of perforation. Prompt diagnosis is the
cornerstone of a good outcome, and early surgical intervention is indicated
if acute appendicitis is suspected. Pregnancy is not a reason to delay
surgery. We review the literature on this topic and present and analyze
principles of management.
