Diagnosis of appendicitis in pregnancy

Abstract 

Background

The diagnosis of appendicitis in pregnant patients is challenging.

Methods

The records of pregnant patients with suspected appendicitis were reviewed.

Results

Forty-seven patients with suspected appendicitis were identified. Twenty-four patients did not undergo surgery. Twenty-three patients had ultrasound (US), none of which visualized the appendix. Seventeen patients were followed up clinically and improved. Six patients had a negative computed tomography (CT) and none required surgery. Twenty-three patients underwent surgery for presumed appendicitis. Three patients had no imaging. Twelve patients had US only; US was positive in 5 patients and all had appendicitis. Seven patients who underwent surgery had a nondiagnostic US. One patient had appendicitis. Seven patients had a positive CT and appendicitis at surgery. One patient had a positive US and magnetic resonance imaging, and had appendicitis. A total of 43 patients had US, of which 86% were nondiagnostic. Six US were read as positive and all patients had appendicitis. Thirteen patients had CT with no false-positive or false-negative results.

Conclusions

US, when read as positive, requires no further confirmatory test other than surgery. If US is nondiagnostic, further imaging may avoid a negative appendectomy.

Keywords: Pregnancy, Appendicitis, Computed tomography, Ultrasound