Location of appendix in pregnancy: does it change?

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Abstract

Objectives

This study aimed to determine the change in anatomical location of appendix in full-term pregnancy.

Study design

This was a descriptive cross-sectional study.

Place and duration of study

Liaquat National University Hospital, Karachi, Pakistan, Department of General Surgery, January 01 to July 31, 2010.

Patients and methods

Full-term pregnant women undergoing caesarean section were enrolled. The anatomical position of the appendix was noted by visual inspection with reference to the transtubercular plane (TTP). SPSS-10 was used for analysis.

Results

Seventy-seven full-term pregnant female patients who underwent caesarean section were included in the study. Their mean age was 29 years, the mean height was 5.3 feet, and mean gestational age was 38 weeks. Appendix was found at the normal anatomical location in 63 out of 77 patients (81.8%), while it was located above the TTP in 14 patients (18.2%).

Conclusion

Appendix does not migrate up with increasing gestational age in the majority of pregnant women. In most full-term pregnant female patients, appendix is located at the normal anatomical position.

Related collections

Most cited references 22

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WSES Jerusalem guidelines for diagnosis and treatment of acute appendicitis

Salomone Di Saverio, Arianna Birindelli, Fausto Catena … (2016)

Acute appendicitis (AA) is among the most common cause of acute abdominal pain. Diagnosis of AA is challenging; a variable combination of clinical signs and symptoms has been used together with laboratory findings in several scoring systems proposed for suggesting the probability of AA and the possible subsequent management pathway. The role of imaging in the diagnosis of AA is still debated, with variable use of US, CT and MRI in different settings worldwide. Up to date, comprehensive clinical guidelines for diagnosis and management of AA have never been issued. In July 2015, during the 3rd World Congress of the WSES, held in Jerusalem (Israel), a panel of experts including an Organizational Committee and Scientific Committee and Scientific Secretariat, participated to a Consensus Conference where eight panelists presented a number of statements developed for each of the eight main questions about diagnosis and management of AA. The statements were then voted, eventually modified and finally approved by the participants to The Consensus Conference and lately by the board of co-authors. The current paper is reporting the definitive Guidelines Statements on each of the following topics: 1) Diagnostic efficiency of clinical scoring systems, 2) Role of Imaging, 3) Non-operative treatment for uncomplicated appendicitis, 4) Timing of appendectomy and in-hospital delay, 5) Surgical treatment 6) Scoring systems for intra-operative grading of appendicitis and their clinical usefulness 7) Non-surgical treatment for complicated appendicitis: abscess or phlegmon 8) Pre-operative and post-operative antibiotics.

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Appendicitis in pregnancy: new information that contradicts long-held clinical beliefs.

Kate L. Erickson, J Mourad, L Lisboa … (2000)

Our purpose was to elicit a better understanding of the presentation of acute appendicitis in pregnancy and to clarify diagnostic dilemmas reported in the literature. We retrospectively reviewed 66,993 consecutive deliveries from 1986 to 1995 by a computer program. Selected records were reviewed for gestational age; signs and symptoms at presentation; complications including preterm contractions, preterm labor, and appendiceal rupture; and histologic diagnosis of appendicitis. Of 66, 993 deliveries, 67 (0.1%) were complicated by a preoperative diagnosis of probable appendicitis. Acute appendicitis was confirmed histologically in 45 (67%) of the 67 cases, for an incidence of 1 in 1493 pregnancies in this population. Distribution of suspected appendicitis in pregnancy was as follows: first trimester, 17 cases (25%); second trimester, 27 (40%); and third trimester, 23 (34%). Right-lower-quadrant pain was the most common presenting symptom regardless of gestational age (first trimester, 12 [86%] of 14 cases; second trimester, 15 [83%] of 18 cases; and third trimester, 10 [78%] of 13 cases). The mean maximal temperature for proven appendicitis was 37.6 degrees C (35.5 degrees C-39.4 degrees C), in comparison with 37.8 degrees C (36.7 degrees C-38.9 degrees C; not significant) for those with normal histologic findings. The mean leukocyte count in patients with proven appendicitis was 16.4 x 10(9)/L (8.2-27.0 x 10(9)/L), in comparison with 14.0 x 10(9)/L (5. 9-25.0 x 10(9)/L) for patients with normal histologic findings. At the time of surgery, perforation had occurred in 8 cases. Of 23 patients at > or =24 weeks' gestational age, 19 (83%) had contractions and an additional 3 patients (13%) had preterm labor with documented cervical change. One patient was delivered in the immediate postoperative period because of abruptio placentae. Pain in the right lower quadrant of the abdomen is the most common presenting symptom of appendicitis in pregnancy regardless of gestational age. Fever and leukocytosis are not clear indicators of appendicitis in pregnancy and preterm labor is a problem after appendectomy, but preterm delivery is rare.

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Laparoscopic versus open appendicectomy in pregnancy: a systematic review.

James Walsh, Tjun Tang, R. Walsh (2008)

Acute appendicitis is the most common non-obstetric indication for surgical intervention in pregnant women. The benefits of a laparoscopic over an open approach to appendicectomy are well established in the non-pregnant population. Data on the optimal surgical approach to acute appendicitis in pregnant women are conflicting. A systematic review of reported cases of laparoscopic appendicectomy (LA) in pregnancy over the period 1990 to 2007. Twenty-eight articles documenting 637 cases of LA in pregnancy were included. Data on pregnancy outcome, patient characteristics, operative technique and peri-operative complications were analysed. The rate of fetal loss following LA in pregnancy approaches 6% and is significantly higher than that following open appendicectomy. Fetal loss was highest in cases of complicated appendicitis. Incidence of preterm delivery appears lower in the LA group although this complication is likely to be under-reported in a significant proportion of cases. Trimester at the time of LA does not appear to influence complication rates. The negative appendicectomy rate in this series was 27%, which is higher than in the non-pregnant population. Complication rates following LA with negative appendicitis are as high as with simple appendicitis. Rates of entry-related complications were 2.8% in the Veress needle group and 0% in the Hasson open entry group. The overall rate of conversion to laparotomy was 1%. No difference was found in the preterm delivery rate between women who received prophylactic tocolysis and those who were not tocolysed. Laparoscopic appendicectomy in pregnancy is associated with a low rate of intra-operative complications in all trimesters. However, LA in pregnancy is associated with a significantly higher rate of fetal loss compared to open appendicectomy. Rates of preterm delivery appear similar or slightly better following a laparoscopic approach. Open appendicectomy would appear to be the safer option for pregnant women for whom surgical intervention is indicated.

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Author and article information

Journal

Journal ID (nlm-ta): Clin Exp Gastroenterol

Journal ID (iso-abbrev): Clin Exp Gastroenterol

Journal ID (publisher-id): Clinical and Experimental Gastroenterology

Title: Clinical and Experimental Gastroenterology

Publisher: Dove Medical Press

ISSN (Electronic): 1178-7023

Publication date Collection: 2018

Publication date (Electronic): 26 July 2018

Volume: 11

Pages: 281-287

Affiliations

[1 ]Department of General Surgery, Liaquat National University Hospital, Karachi, Pakistan, aishaq@ 123456dha.gov.ae

[2 ]Department of Medicine, Dubai Hospital, Dubai, UAE

[3 ]Surgical Oncology Department, Shaukat Khanum Hospital, Lahore, Pakistan

Author notes

Correspondence: Aliya Ishaq, General Surgery Department, Dubai Hospital, Albaraha Street, Dubai 7272, UAE, Tel +971 50 193 7655, Email aishaq@ 123456dha.gov.ae

Article

Publisher ID: ceg-11-281

DOI: 10.2147/CEG.S154913

PMC ID: 6065566

SO-VID: c72412a8-a987-4278-90b1-d79d64506e66

License:

The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

Location of appendix in pregnancy: does it change?

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Abstract

Objectives

Study design

Place and duration of study

Patients and methods

Results

Conclusion

Related collections

HLA-G and immune tolerance in pregnancy

Most cited references 22

WSES Jerusalem guidelines for diagnosis and treatment of acute appendicitis

Appendicitis in pregnancy: new information that contradicts long-held clinical beliefs.

Laparoscopic versus open appendicectomy in pregnancy: a systematic review.

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