Ali Omar Almaati, Ibrahim Ali Jabeal, Khaled Farag Mohamed
Surgical Department, Tripoli Medical Centre. Tripoli-Libya
JMJ Vo1.7 No.1 (Spring) 2007:27-30
Abdominal pain, nausea and vomiting are common during pregnancy and may or may not be the symptoms of appendicitis.
Objective: To evaluate the clinical performance in the diagnosis of appendicitis in pregnancy. To identify the factors associated with complication and evaluate the rule of laboratory studies and ultrasound results in diagnosis. Methods: Retrospective study of twenty seven (27) pregnant patients operated upon for suspected appendicitis in Tripoli Medical Centre in the years 2003, 2004 and 2005. Age of the patient, gestational age, clinical presentation which included abdominal pain, nausea, vomiting, anorexia, dysuria, tenderness, onset, and time lapse before admission, laboratory studies (Hb, WBC, Urine), Ultrasound, antibiotics, operative findings, complication and post operative hospital stay all were studied. Results: 92.6% of the patient aged between 20-35, 74.1% their ages ranged between 20-30 and only 2% were above 35 years old, 18.5% of these patients were pregnant in the first trimester, 59.3% were in the second trimester and 22.2% were in the third trimester. All patients presented with abdominal pain and tenderness, 77.8% of the patients had nausea and anorexia, 48.1% had history of vomiting, 37% came to the hospital in the first day of their complaint, 40.7% came in the second day, 18.5% came in the third day and 3.7% came after four days from the start of their symptoms. 48% had anaemia (Hb below 10 mg), 33% had normal white blood cells, 66.6% had leukocytosis (more than 10,000), ultrasound did not give any information regarding appendicitis but it excluded gynaecological causes, all patients had surgery, 81.5% had acute inflamed appendix, 7.4% had perforated appendix, 3.7% had early formed mass, 7.4% had normal appendix, only one patient had wound infection (3.7%) and one had abortion before discharge (3.7%). Conclusion: 1-Pregnancy makes it difficult to confirm the diagnosis of appendicitis 2-In hospitals with limited available medical imaging facilities, clinical observation and repeated examination was not associated with an increased incidence of complication. 3-Acute appendicitis with peritonitis carries high risk to the mother and foetus. 4-Surgery in the early stages of appendicitis is safe to the mother and foetus.
Keywords: Appendicitis – Pregnancy