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Aras A et al.
622 Rev Assoc M ed Bras 2016; 62(7):622-627
ORIGINAL ARTICLE
The diagnosis of acute appendicitis in pregnant versus non-pregnant
women: A comparative study
Abbas Aras 1*, Erbil Karaman2, Çağhan pekşen3, Remzi Kızıltan1, Mehmet Çetin Kotan4
1Assistant Professor, Department of General Surgery, School of Medicine, Yüzüncü Yıl University, Van, Turkey
2Assistant Professor, Department of Obstetrics and Gynecology, School of Medicine, Yüzüncü Yıl University, Van, Turkey
3Research Assistant, Department of General Surgery, School of Medicine, Yüzüncü Yıl University, Van, Turkey
4Professor, Department of General Surgery, School of Medicine, Yüzüncü Yıl University, Van, Turkey
Summary
Study conducted at the
Department of General Surgery
and at the Department of Obstetrics
and Gynecology, School of Medicine,
Yüzüncü Yıl University, Van, Turkey
Article received: 6/26/2015
Accepted for publication: 9/28/2015
*Correspondence:
Address: Merkez kampus, 65000
Van – Turkey
Objective: To investigate whether the diagnosis of acute appendicitis is affected
by pregnancy or not.
Method: A retrospective study with the analysis of the medical records of all
women suspected of having appendicitis who underwent appendectomy at our
hospital between June 2010 and March 2015 were reviewed. The patients were
divided into two groups according to whether they were pregnant or not during
the surgery: group I, pregnant women, and group II, non-pregnant women.
Results: During the study period, 38 pregnant women and 169 non-pregnant
women underwent appendectomy. The time from admission to the operation
was not statistically different (2.17±1.47 days in group I vs. 1.98±1.66 day in
group II; p=0.288). The pregnant group had longer hospital stay than the non-
pregnant group (p=0.04). Ultrasonography (USG) was used as the first diagnos-
tic modality in 36/38 patients in group I and 161/169 in group II. The non-vi-
sualized appendix on ultrasound was seen in 17 patients in group I and 51
patients in group II, which was not statistically different. Sensitivity and specific-
ity of USG in diagnosis of acute appendicitis were 61.29 and 80.00% in group I,
and 93.0 and 31.6% in group II, respectively.
Conclusion: Although the diagnosis of appendicitis in pregnant women is not
delayed, careful assessment of these patients suspected of having appendicitis
should be encouraged when USG examination is normal or nondiagnostic.
Keywords: appendicitis, pregnancy, ultrasonography, diagnosis.
Introduction
Appendicitis is the most common non-obstetric surgical
emergency during pregnancy, occurring in 1 in 1,000
births reported by a large cohort study including 7,114
pregnant women with appendicitis.1 The diagnosis of
appendicitis during pregnancy is challenging and it is
reported that 25 to 50% of patients had incorrect preop-
erative diagnosis for several reasons.2 Due to the symptoms
and complaints such as nausea, loss of appetite, vomiting,
and mild-lower abdominal pain are frequent during the
normal pregnancy and also in acute appendicitis, it is
reasonable to make efforts to increase and facilitate the
early diagnosis and treatment of acute appendicitis.3
It has been reported that any delay or misdiagnosis
of acute appendicitis will eventually result in perforated
or complex appendicitis with peritonitis, which is associ-
ated with high rates of early delivery, miscarriage, and
fetal loss.4 Despite the tendency to late diagnosis of acute
appendicitis during pregnancy, it is reported up to 23%
of negative appendectomy rate. 5 However, a recent study
reported that higher rates of adverse obstetric outcomes
were observed amongst pregnant women with negative
appendectomy. 6 Ultrasonography (USG) is a non-invasive
and inexpensive test, which does not expose the patient
to radiation, and is reported to have sensitivity and spec-
ificity of 86 and 81% for the diagnosis of acute appendi-
citis, respectively. 7 The major disadvantage of USG is its
operator dependent character. There are also speculations
that the physiological and anatomical changes due to the
gravid uterus within the abdomen make the diagnosis of