Appendicitis Research Today is a free monthly online journal that collates and summarizes the latest research about Appendicitis, including details on symptoms, surgery, causes, treatment.

Appendicitis in pregnancy: an ongoing diagnostic dilemma.

Brown JJ, Wilson C, Coleman S, Joypaul BV

Department of Surgery South Tyneside NHS Foundation Trust Hospital, Newcastle Upon Tyne, United Kingdom.

Introduction: Appendicitis in pregnancy (AIP) is the most common non-obstetric cause of an acute abdomen requiring surgical intervention. Diagnostic difficulties arising from gestational symptoms compound the risk of foetal loss after negative appendicectomy and exponentially increase the risk to mother and foetus with delay in genuine cases. In this article we investigate the symptoms and signs of AIP and attempt to identify consistent clinical features and review the role of imaging in diagnosis. Methods: MEDLINE and Pubmed were searched for case control studies recording preoperative symptoms/signs suggestive of AIP as well as appendiceal pathology. Combined likelihood and odds ratios (OR) were created for clinical features across homogenous papers. Papers examining the use of laparoscopy, UltraSound, Computerised Tomography and Magnetic Resonance Imaging were assessed qualitatively. Results: Seven papers met the inclusion criteria for analysis of consistent clinical features (450 patients). The only symptoms or signs significantly associated with a diagnosis of appendicitis were nausea (OR 2.21, 95%CI 1.34-3.66), vomiting (OR 0.82-15.6 range) and peritonism (OR 1.80, 95%CI 1.06-3.04). USS, CT and MRI have all been used to successfully diagnose appendicitis in pregnancy. Laparoscopic appendicectomy has been safely undertaken in pregnancy. Conclusions: Appendicitis will continue to challenge the diagnostic acumen of surgeons. Whilst useful, consensus regarding the safety of laparoscopy, CT and MRI in pregnancy is yet to be achieved.

Published 2 June 2008 in Colorectal Dis.
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