Location of appendix in pregnancy: does it change?

2016

SUMMARY. Objective. An evaluation of the the clinical picture, diagnostic procedures and outcome of appendicitis in pregnant women. Method. Retrospective analytic study of 28 appendectomies performed during pregnancy for sus-pected appendicitis in our hospital at period April 2004 to September 2006. All files and medical records of these patients were analyzed and studied. The including variables (demographic, clinical, laboratory and surgical outcomes data) were collected retrospectively. The number of correct and wrong diagnosis were reported and comparison of perinatal out-come, maternal morbidity and different variables in negative and positive laparotomy performed. Results. The preva-lence of suspected appendicitis in pregnancy is 0.29%. Incidence of negative laparotomies was 36%. The most correct diagnostic findings for acute appendicitis were history of periumbilical pain, anorexia and iliac fossa findings. Delayed surgical intervention significantly increased maternal morbid...

Background: Vermiform appendix is a vestigial organ of variable position in the abdomen. Its location, size and shape are subject to alterations with the race of the population and limited information is available on developmental morphology and morphometry of fetal appendix. Materials and Methods: In the present study 60 appendix specimens from aborted human fetuses of 17-40 weeks gestational age and both sexes were studied by dissection method for age related morphological features and morphometric parameters. The morphological parameters observed include its location in relation to abdominal region, caecum and ileum, clock position, position of base in relation to caecal wall and direction of tip of appendix. The morphometric parameters of length, diameter and distance between ileo-caecal orifice and appendicular orifice were measured. Results: The location of appendix in relation to abdominal region presented higher incidence of sub-hepatic position in less than 30 weeks fetuses...

https://www.ijhsr.org/IJHSR_Vol.7_Issue.5_May2017/IJHSR_Abstract.07.html, 2017

Introduction:-Appendix is a wormlike structure arises from posteromedial wall of the cecum, about 2 cm below the ileocecal valve. Though a remarkably constant structure, the appendix is occasionally subject to the extremes of variation, Signs and symptoms may show varying degree of discrepancy depending on position of the appendix. The aim of our study is to determine the position of the appendix in a group of patients examined by the authors. Results:-The positions of the appendix found were as follow :-retrocecal: 66% , pelvic: 27%, post-ileal: 3% , subcecal: 2% , paracecal: 1% , pre-ileal: 1%. Discussion:-In our study retrocecal is the most common position, followed by pelvic> post-ileal>subcecal>paracecal>pre-ileal. The result of our study is correlating with some study in which retrocecal position is most common and contradicting with some study in which pelvic position is most common (Table 1).symptom and sign is different in various position and mimics other condition which leads to misdiagnosis. In the subcecal position, the appendix is intraperitoneal if inflamed, it can cause diffuse peritonitis. Thus, this position can be regarded as the most susceptible to complications. In pelvic position appendicitis may mimics with cystitis. In pre or post ileal position may irritate intestine and mimics gastroenteritis. Conclusion:-After the study strong association has been found between hidden locations of the appendix and the development of an advanced appendicitis, which results in longer hospital stay and high incidence of gangrene and perforation.

Acta Obstetricia et Gynecologica Scandinavica, 1999

Background. Acute appendicitis is the most common surgical emergency in pregnancy. The purpose of this study is to investigate the clinical presentation, management and outcome in patients who underwent appendectomy during pregnancy. Material and methods. The case records of 56 women who underwent appendectomy during pregnancy between January 1985 and December 1997 were reviewed and analyzed. Results. The incidence of appendicitis in pregnancy was one in 766 births. The preoperative diagnosis was correct in 75% of the cases. Uterine contractions and a history of diffuse or periumbilical pain migrating to the right lower abdominal quadrant were significantly more frequent among women with appendicitis compared to those patients where the appendectomy revealed a normal appendices. Abdominal pain, nausea, vomiting, leukocyte count, CRP and body temperature were not helpful in establishing the correct diagnosis. There was no maternal morbidity related to the appendectomy. Pregnancy complications were found to be considerable: 4/12 (33%) who underwent appendectomy for appendicitis during the first trimester aborted spontaneously. Second trimester appendectomy for appendicitis was followed by premature delivery in 4/28 (14%). However, no pregnancy complications were observed following third trimester appendectomy for appendicitis. We found no increase in pregnancy complications in cases with perforated appendicitis. Conclusion. Appendicitis in pregnancy should be suspected when a pregnant woman complains of new abdominal pain. No laboratory finding was found to be diagnostic for acute appendicitis during pregnancy. Considerable fetal loss was found after appendectomy during pregnancy in the first and second trimester. No increase in pregnancy complications in cases with perforated appendicitis was observed. The combination of symptoms and clinical judgement is still vital in deciding which patient needs surgical treatment. Based on the results in the present study we recommend prophylactic antibiotic treatment in all laparotomies during pregnancy when appendicitis is suspected.

Turkish journal of trauma & emergency surgery, 2020

BACKGROUND: This retrospective study aims to compare the demographic and clinicopathological characteristics of the pregnant and non-pregnant patients who underwent appendectomy with a presumed diagnosis of acute appendicitis. Between June 2009 and January 2019, 431 reproductive-aged of female patients underwent appendectomy with a presumed diagnosis of acute appendicitis. Patients were divided into two groups considering their pregnancy status: pregnant group (n=48) and non-pregnant group (n=383). Both groups were compared with respect to demographic, clinical and histopathological features. No statistically significant difference was found between pregnant and non-pregnant groups except total bilirubin level (p=0.019) and ultrasonographic findings (p=0.016). In the non-pregnant group, negative appendectomy and perforation rates were 26% and 10.5%, where these rates for the pregnant group were 20.8% and 4.2%. Sensitivity, specificity and accuracy rates of ultrasonography for the pregnant group were 50%, 100% and 58.5%, where these rates for the non-pregnant group were 67.3%, 57.9% and 65%. The pregnancy date was the first trimester in 52.1%, the second trimester in 29.2% and the third trimester in 16.7% of the pregnants. None of the term births (87.5%) resulted in neither a fetal nor a maternal complication. However, 12.5% of the preterm births resulted in neonatal mortality. Although not statistically significant, this study points out relatively lower rates of negative appendectomy and perforated acute appendicitis among pregnant patients, which is related to the overly attentive evaluation of pregnants admitted due to acute abdomen.

Journal of College of Medical Sciences-Nepal, 2012

To evaluate the clinical picture and outcome of suspected appendicitis in pregnant women. Retrospective analytic study of 28 appendectomies performed during pregnancy for suspected appendicitis in our hospital at period April 2004 to September 2006. All files and medical records of these patients were analyzed and studied. Those including variables (demographic, clinical, laboratory and surgical outcomes data) were collected retrospectively. Prevalence of appendicitis was calculated from the total number of deliveries and abortions that occurred during this period. Numbers of correct and wrong diagnosis were reported and comparison of perinatal outcome, maternal morbidity and different variables in negative and positive laparotomies performed. The prevalence of suspected appendicitis in pregnancy is 0.29%. Incidences of negative laparotomies were 36%. The most diagnostic findings for acute appendicitis were history of periumbilical pain, anorexia and Rt iliac fossa findings. Half of...

Journal of the Nuffield Department of Surgical Sciences

Acute appendicitis is the most common non-obstetric surgical emergency during pregnancy. This report presents a case of conservative management of appendicitis during pregnancy. The aim is to discuss the role of conservative treatment for a condition that is routinely treated surgically. This is important because research on the management of appendicitis during pregnancy is limited compared to the general population. Conservative management can be a safe option for uncomplicated appendicitis. However, the increased risk of appendix perforation in pregnancy and implications for foetal health commonly make surgery a more attractive option. This risk is a key driver for higher rates of negative appendectomies during pregnancy. The COVID-19 pandemic provides a unique opportunity to remedy the paucity of research of appendicitis during pregnancy. This is because conservative management was heavily utilised at the start of the pandemic. Therefore, following up pregnant patients in this c...

Lietuvos chirurgija

Objective. This study was designed to compare the diagnosis, treatment, and results of acute appendicitis in pregnant and non-pregnant women. Material and Methods. Women between the ages of 18 and 40 who were operated for acute appendicitis between 2015 and 2020 were included in the study. Results. There were 27 (3.8%) patients in Group Pregnant, and 679 (96.2%) patients in Group non-Pregnant. The mean WBC values in Group P and Group non-P was 16.53±2.91 and 13.99±4.31 (x103), and there was a significant difference between the groups.Mean pain symptom duration time was 3.40±1.90 in Group P and 1.91±1.34 day in Group non-P, while it was significantly longer in Group P . When the preoperative USG reports were evaluated, no significant difference was found between the groups.The diagnosis was made by MRI in 2 (7.4%) pregnant patients who non-visualized according to the USG report. In Group P, 10 patients were laparoscopic, 17 patients open; In group non-P, 153 patients laparoscopic and...

Surgical and Radiologic Anatomy, 2007

Background The vermiform appendix has no constant position and the data on the variations in its position are limited. The aim of this study was to determine the frequency of the various positions of the appendix at laparoscopy. Methods Patients undergoing emergency or elective laparoscopy at a university teaching hospital between April and September 2004 were studied prospectively. The positions of the appendix and the caecum were determined after insertion of the laparoscope, prior to any other procedure and the relative frequencies calculated. Results A total of 303 (102 males and 201 females) patients with a median age of 52 years (range 18-93 years) were studied. An emergency appendicectomy was performed in 67 patients, 49 had a diagnostic laparoscopy, 179 underwent a laparoscopic cholecystectomy and eight had other procedures. The caecum was at McBurney's point in 245 (80.9%) patients, pelvic in 45 (14.9%) and high lying in 13 (4.3%). The appendix was pelvic in 155 (51.2%) patients, pre-ileal in 9 (3.0%), para-caecal in 11 (3.6%), post-ileal in 67 (22.1%) and retrocaecal in 61 (20.1%) patients. Conclusion Contrary to the common belief the appendix is more often found in the pelvic rather than the retrocaecal position. There is also considerable variation in the position of the caecum.

Sri Lanka Journal of Obstetrics and Gynaecology, 2012

Background: The preoperative diagnosis of acute appendicitis is often inaccurate i n pregnant women, and complicated appendicitis is associated with a high rate of fetal loss. Objective: Our purpose was to elicit a better understanding of the presentation of acute appendicitis in pregnancy and to clarify diagnostic dilemmas reported in the literature. Study design: We retrospectively reviewed 15216 deliveries from June 2009 to December 2011. Selected records were reviewed for gestational age, signs and symptoms at presentation, complications and, histologic diagnosis of appendicitis. Results: Of 15216 deliveries, 15 (0.1%) were complicated by a preoperative diagnosis of probable appendicitis. Acute appendicitis was confirmed histologically in 12 (80%) of the 15 cases. Right-lower-quadrant pain was the most common presenting symptom regardless of gestational age (first trimester [100%]; second trimester, [80%]; and third trimester, [60%]). The mean maximal temperature for proven appendicitis was 37.6°C, in comparison with 37.8°C (not significant) for those with normal histologic findings. The mean leukocyte count in patients with proven appendicitis was 16.4 × 10 9 /L (8.2-27.0 × 10 9 /L), in comparison with 14.0 × 10 9 /L (5.9-25.0 × 10 9 /L) for patients with normal histologic findings. At the time of surgery, appendiceal perforation was found in 2 cases. Conclusion: Pain in the right lower quadrant of the abdomen is the most common presenting symptom of appendicitis in pregnancy