Incidence of Acute Appendicitis during Pregnancy and Outcome of Appendectomy in Ramathibodi Hospital
Nuttapon Arpornsujaritkun MD*, Weerapat Suwanthanma MD**
Affiliation : * Division of Vascular and Transplant, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand ** Division of General Surgery, Department of Surgery, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
Background : Acute appendicitis is the most common surgical problem during pregnancy. This review study investigates
clinical presentation, risk, outcome in pregnancy patient who have the diagnosis of acute appendicitis and outcome of
appendectomy in Ramathibodi Hospital in the past 10 years.
Objective : To investigate clinical outcome of appendectomy in pregnancy patient who have the diagnosis of appendicitis.
Material and Method: The record data of 45 women with diagnosis of acute appendicitis that underwent appendectomy
between January 2006 and December 2016 in Ramathibodi Hospital were reviewed.
Results : Forty-five pregnant women received a diagnosis of acute appendicitis. Incidence of acute appendicitis during
pregnancy was 0.13%. Median gravida was 1. Mean gestational age was second trimester (18.53+8.48 weeks). All cases
presented with right lower quadrant pain, but no specific signs or symptoms (no fever 88.7%, nausea and vomiting 60%,
anorexia 60%, rebound tenderness 60%, or migratory pain 51.1%). Complete blood count revealed leukocytosis in 97.78%
with PMN predominate of patient. Diagnosis was made by ultrasonography 88.9%, which could identify appendix in only
42.5%. All identified appendix were confirmed to be acute appendicitis by pathologist. The rate of perforation was 20%. The
fetus was delivered full term in 84.44%. Significant perforated appendicitis was found in late second trimester (17.11+7.53 vs.
24.22+10.08 weeks, p = 0.023). The patient in the perforated group had prolonged hospital stay of about two days 4 (3 to 5)
vs. 6 (4 to 8) days, p = 0.015). No significant difference in operative time, or morbidity and mortality of fetus in patient with
delayed time to surgery after diagnosis.
Conclusion : No specific signs and symptoms of acute appendicitis were found in pregnant women. Leukocytosis alone cannot
be used to diagnose acute appendicitis. Ultrasonography remains the first choice modality for diagnosis. Second choice
modality is MRI. Third trimester showed increase risk of perforated appendicitis. Perforated appendicitis results in prolonged
hospital stay and operative time.
Keywords : Acute appendicitis, Pregnancy, Outcome appendectomy
