Acute Appendicitis in Pregnancy: How to Manage?

Objectives: Acute appendicitis during pregnancy may be associated with severe maternal and fetal complications. The clinical, laboratory and radiological parameters used in diagnosis and the effects of the surgical method and timing on the results are controversial. The present study aims to reveal the relationship between clinical approach, surgical treatment methods and complications in pregnant women with suspected acute appendicitis.
Methods: Between December 2007 and August 2019, 21 pregnant women who underwent appendectomy were included in this study. Age, gestational age, complaints at admission, leukocyte count, radiological examination results, type of surgery (conventional or laparoscopic), histopathology results, time from admission to operation, maternal and fetal complications were retrospectively evaluated.
Results: The number of patients who developed complications was six (28.6%). Three (14.3%) of these patients had preterm birth and three (14.3%) had an abortion. There was no statistically significant relationship between trimester and complication (p=0.747). Fourteen patients (66.7%) underwent laparoscopic surgery and seven patients (33.3%) underwent conventional surgery. Although the complication rate was higher in the laparoscopic group, there was no statistically significant difference (p=0.306). The fetal loss rate in the series was 14.3% and all were in the laparoscopic group. However, there was no statistically significant difference between the groups (p=0.158).
Conclusion: Pregnancy-related limiting factors may complicate the diagnosis of acute appendicitis. These patients definitely need a more skeptical assessment and additional diagnostic tools beyond the standard clinical approach. Although laparoscopic appendectomy appears to be a safe option in treatment, its relationship with a higher risk of fetal loss should be kept in mind.

Gebelikte Akut Apandisit: Nasýl Yönetilir?

Amaç: Gebelikte akut apandisit ciddi maternal ve fetal komplikasyonlar ile iliþkili olabilmektedir. Gerek tanýda kullanýlan klinik, laboratuvar ve radyolojik parametreler gerekse seçilen ameliyat yöntemi ve zamanlamasýnýn sonuçlara etkisi tartýþmalýdýr. Bu çalýþmada akut apandisit þüphesi olan gebe hastalarda ayýrýcý tanýda kullanýlan klinik yaklaþýmýn ve cerrahi tedavi yöntemlerinin komplikasyonlar ile olan iliþkisinin ortaya konulmasý amaçlandý.
Yöntem: Aralýk 2007 ile Aðustos 2019 tarihleri arasýnda apendektomi yapýlan 21 gebe hasta çalýþmaya dahil edildi. Yaþ, gebelik yaþý, baþvuru esansýndaki þikayetler, lökosit sayýsý, radyolojik inceleme sonuçlarý, cerrahi yöntem (konvansiyonel veya laparoskopik), histopatoloji sonuçlarý, baþvurudan ameliyata kadar geçen süre, maternal ve fetal komplikasyonlar retrospektif olarak deðerlendirildi.
Bulgular: Komplikasyon geliþen hasta sayýsý 6 (%28,6) idi. Bu hastalarýn yarýsýnda (%14.3) erken doðum, diðer yarýsýnda (%14.3) abortus geliþti. Trimester ile komplikasyon geliþimi arasýnda istatistiksel olarak anlamlý bir iliþki bulunmadý (p=0.747). On dört hastaya (%66.7) laparoskopik cerrahi, 7 hastaya (% 33.3) konvansiyonel cerrahi uygulandý. Laparoskopik grupta komplikasyon oraný daha yüksek olmasýna raðmen istatistiksel olarak anlamlý fark saptanmadý (p=0.306). Serideki fetal kayýp oraný %14.3 olup tamamý laparoskopik gruptaydý. Ancak gruplar arasýnda istatistiksel olarak anlamlý fark yoktu (p=0.158).
Sonuç: Gebeliðe baðlý sýnýrlayýcý faktörler akut apandisit tanýsýný zorlaþtýrmaktadýr. Bu hastalar için standart klinik yaklaþýmýn ötesinde çok daha þüpheci bir tutum ve ek taný araçlarý þarttýr. Tedavide laparoskopik apendektomi güvenli bir seçenek olarak görünse de daha yüksek fetal kayýp riski ile olan iliþkisi göz önünde tutulmalýdýr. (SETB-2020-05-078)