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Appendicitis in pregnancy: an ongoing diagnostic dilemma
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Dr James Brown
Dr Shirley Coleman
Brown JJS, Wilson C, Coleman S, Joypaul BV
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Appendicitis in pregnancy is the most common non-obstetric cause of an acute abdomen, presenting both considerable diagnostic difficulty and the risk of foetal loss. This article reviews the symptoms and signs of appendicitis in pregnancy and the role of imaging in the diagnosis.
MEDLINE and the Cochrane Controlled Trials Register (CCTR) were searched for case control studies recording preoperative symptoms and signs as well as appendiceal pathology in pregnancy. Combined likelihood and odds ratios (OR) were calculated using standard meta-analysis techniques. Papers examining the use of laparoscopy, ultrasonography (USS), computerised tomography (CT) and magnetic resonance imaging (MRI) were assessed qualitatively.
Seven papers met the inclusion criteria for the meta-analysis (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). Laparoscopy, USS, CT and MRI have all been used to successfully diagnose appendicitis in pregnancy.
Appendicitis will continue to challenge the diagnostic acumen of surgeons, although the use of imaging and laparoscopy may be helpful. Uncertainty still remains about the safety of laparoscopy, CT and MRI in pregnancy.
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