Surgical Emergencies in Pregnancy: A study of 120 cases

Original article


M. Elawami and N. Mital

Department of Surgery, Faculty of Medicine, Garyounis University, AL Jalla Hospital, Benghazi, Libya

JMJ Vol. 1, No. 2 (November 2001): 63-66


Acute abdominal pain in pregnancy is a big dilemma to an attending general surgeon. Among various causes, acute appendicitis is the most common surgical entity, which requires emergency surgery. The present study aimed to analysis 120 pregnant patients who were admitted to the surgical wards of Al Jala hospital, Benghazi, between June 96 to December 98. Ninety-six (80%) patients were diagnosed as acute appendicitis. There were 20 (21%) in the first trimester, 56 (58%) in the second trimester, 18 (19%) in the third trimester, and 2 (2%) patients in the puerperium. Pain in the right lower quadrant was the most common symptom. Tenderness and rebound tenderness in the right iliac fossa were the most common signs to decide for exploration. Laboratory investigation of leucocytosis and a left shift of granulocytes were helpful in reaching a decision for operation. Appendicectomy was performed by a gridiron incision in 79 (82%) of cases, the remaining via midline incision. Perforation was found in 6 (8%) cases whose symptoms exceeded 2 days. Wound infection occurred in 8 (8.6%) of cases, 3 of them had a perforated appendix. Eight (6.6%) of patients were diagnosed as having ectopic gestation. Diagnosis is often delayed due to changes in symptoms and signs due to upward displacement of the caecum and appendix by the advancing uterus. This causes perforation and peritonitis leading to increased maternal morbidity and foetal mortality.

Keywords: Surgical emergencies, pregnancy, acute appendicitis, and ectopic gestation