Appendicitis in pregnancy: an ongoing diagnostic dilemma

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  2. Dr James Brown
  3. Dr Shirley Coleman
Author(s)Brown JJS, Wilson C, Coleman S, Joypaul BV
Publication type Article
JournalColorectal Disease
ISSN (print)1462-8910
ISSN (electronic)1463-1318
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Introduction: 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. Methods: 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. Results: 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. Conclusions: 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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