Acute appendicitis
in relation to
pregnancy
Features, diagnosis, management and outcomes of all
cases at Landspitali University Hospital in Iceland 19942010
Thorhallsdottir H, Valsdottir EB, Bjarnadottir RI, Strandell A.
VECKAN 2015
• Redovisning av intressekonflikter/jäv:
• Det finns inga intressekonflikter eller jäv att
redovisa.
Aims
To analyze acute appendicitis in pregnant and
early postpartum Icelandic women:
 Incidence, diagnosis, management and
outcomes
 If time from admission to surgery influenced
the risk of having a perforated appendicitis
and subsequent complications
Pregnant patients with suspected appendicitis
Pregnant patients
44
Acute surgery
42
No
appendectomy
5
Appendectomy
37
Positive
histology
31
Negative
histology
6
Antibiotics
2
Non-surgical
explanation
3
*emergency surgery on fetal indication
Gynaecological
pathology
2
Cesaerian section*
two weeks later.
No appendectomy
1
No signs of
appendicitis at
surgery
1
Elective
surgery
1
Positive
histology
1
Table 1: Primary surgical approaches for appendectomy in the pregnant population
Total number
of patients
Acute surgery
Laparoscopy
Laparotomy
Caesarean section
n=44
n=42
n=33
n=8
n=1
1st trimester
16
16
15
1
.
2nd trimester
21
20
14*
6
0
3rd trimester
7
6
4
1
1
Gestational
age
Frequency distribution across trimesters of all pregnant patients with suspected
appendicitis (n=44), presented by histological, surgical and clinical findings.
24
22
20
18
no surgery
16
14
negative histology
12
no
appendendicitis/appendecto
my at surgery
10
8
positive histology
6
4
2
0
1st
2nd
3rd
The relationship between time from admission
to surgery and perforation of the appendix (n=42)
Mann-Whitney U test,
p = 0.04
Discussion
Styrkor / svagheter
• Samtliga med suspekt • Ändå ett litet material
appendicit under 17
år
• Ingen kontrollgrupp
• Ett center som täcker • Saknas data på
73% av alla födslar på
symptomduration
Island
Conclutions



Incidence 0.63 per 1000 births
Laparoscopy - most common surgical
approach across all trimesters
Perforated appendicitis associated with:



increased time from admission to surgery
increasing gestational age
Major complications:

premature delivery and perinatal death