Rahman ŞENOCAK, Süleyman Utku ÇELİK, Şahin KAYMAK

GEBE KADINLARDA GÖRÜLEN AKUT APANDİSİTİN TANI, TEDAVİ VE KLİNİKOPATOLOJİK ÖZELLİKLERİ VE FETAL SONUÇLAR ÜZERİNE ETKİSİ

Amaç: Çalışmanın amacı gebe kadınlarda görülen apandisitin tanı ve tedavi stratejileri ile klinikopatolojik özellikleri ve feto-maternal sonuçlarını değerlendirmektir. Gereç ve Yöntem: Bu çalışmada apendektomi yapılan 17 gebe kadın ve yaşları eşleştirilmiş 59 gebe olmayan kadın laboratuvar bulguları, preoperatif ultrasonografi (USG), patoloji ve klinik sonuçlar açısından karşılaştırıldı. Bulgular: Toplam USG tarama sayısı, görüntülenemeyen apandis oranları ve hastanede kalış süreleri gebe kadınlarda gebe olmayan kadınlara göre daha fazla idi (sırasıyla P<0,001, P=0,035 ve P=0,014). Gebe grupta negatif apendektomi oranı gebe olmayanlara göre 1,5 kat, komplike apandisit oranı ise 7 kat daha yüksekti. USG’nin tanısal doğruluğu ise gebe olmayan grupta daha yüksek bulundu (%72,9’a karşı %64,7). Hematolojik parametreler açısından apandisit olan ve olmayan gebe hastalar arasında anlamlı bir fark bulunmadı. İkinci trimesterde bir erken doğum ve bir abortus görülürken, üçüncü trimesterde bir hastada negatif apendektomiyi takiben bir erken doğum gerçekleşti. Sonuç: Gebelik sırasında laboratuvar parametreleri ve USG ile konulan apandisit tanısı hatalı olabilmektedir. Bu yüzden, gereksiz cerrahi müdahalelerden kaçınmak için, klinisyenlerin hamilelik sırasında apandisitten şüphelendikleri durumlarda ek görüntüleme tetkikleri yapmayı düşünmelerini öneririz. Çünkü hem negatif apendektomi hem de komplike apandisit, ihmal edilemez bir fetal morbidite ve mortalite oranıyla sonuçlanabilir.

Anahtar Kelimeler:

Akut apandisit, gebelik, morbidite

DIAGNOSIS, MANAGEMENT AND CLINICOPATHOLOGICAL FEATURES OF ACUTE APPENDICITIS IN PREGNANT WOMEN AND ITS IMPACT ON FETAL OUTCOMES

Objective: To evaluate the clinicopathological features and feto- maternal outcomes of appendicitis during pregnancy. Material and Method: This study involved comparisons of laboratory findings, preoperative ultrasonography (US), pathology and clinical outcomes of 17 pregnant and 59 age-matched non-pregnant women undergoing appendectomy. Results: The total number of US scans, rates of non-visualized appendix on US, and length of hospital stay were higher in pregnant women than in non-pregnant subjects (P<0.001, P=0.035, and P=0.014; respectively). The rate of negative appendectomy was 1.5-times higher and the rate of complicated appendicitis was 7-times higher in pregnant compared with non-pregnant patients. The diagnostic accuracy of US was higher in the non-pregnant group (72.9% vs. 64.7%). In terms of the hematological parameters, no significant difference was found between the pregnant patients with and without appendicitis. There was one premature birth and one abortus in the second trimester, and one premature birth followed by a negative appendectomy in the third trimester. Conclusion: The diagnosis of acute appendicitis in pregnancy may remain inconclusive despite comprehensive evaluation with clinical examination, laboratory studies, and US. We recommend that clinicians consider additional imaging scans when they suspect appendicitis during pregnancy to avoid unnecessary surgical interventions. Both complicated appendicitis and negative appendectomy can cause a non-negligible rate of fetal morbidity and mortality.

Keywords:

Acute appendicitis, morbidity, pregnancy,

PDF

___

1. Abbasi N, Patenaude V, Abenhaim HA. Management and outcomes of acute appendicitis in pregnancy-populationbased study of over 7000 cases. BJOG 2014;121(12):1509- 14.
2. Andersen B, Nielsen TF. Appendicitis in pregnancy: diagnosis, management and complications. Acta Obstet Gynecol Scand 1999;78 (9):758-62.
3. Aras A, Karaman E, Peksen C, Kiziltan R, Kotan MC. The diagnosis of acute appendicitis in pregnant versus nonpregnant women: A comparative study. Rev Assoc Med Bras 2016;62(7):622-7.
4. Hee P, Viktrup L. The diagnosis of appendicitis during pregnancy and maternal and fetal outcome after appendectomy. Int J Gynaecol Obstet 1999;65(2):129-35.
5. McGory ML, Zingmond DS, Tillou A, Hiatt JR, Ko CY, Cryer HM. Negative appendectomy in pregnant women is associated with a substantial risk of fetal loss. J Am Coll Surg 2007;205(4):534-40.
6. Pedrosa I, Lafornara M, Pandharipande PV, Goldsmith JD, Rofsky NM. Pregnant patients suspected of having acute appendicitis: effect of MR imaging on negative laparotomy rate and appendiceal perforation rate. Radiology 2009;250(3):749-57.
7. Ueberrueck T, Koch A, Meyer L, Hinkel M, Gastinger I. Ninety-four appendectomies for suspected acute appendicitis during pregnancy. World J Surg 2004;28(5):508- 11.
8. Woodfield CA, Lazarus E, Chen KC, Mayo-Smith WW. Abdominal pain in pregnancy: diagnoses and imaging unique to pregnancy--review. Am J Roentgenol 2010;194(6 Suppl):WS14-30.
9. Aggenbach L, Zeeman GG, Cantineau AE, Gordijn SJ, Hofker HS. Impact of appendicitis during pregnancy: no delay in accurate diagnosis and treatment. Int J Surg 2015;15:84-9.
10. Ibiebele I, Schnitzler M, Nippita T, Ford JB. Appendicectomy during pregnancy and the risk of preterm birth: A population data linkage study. Aust N Z J Obstet Gynaecol 2019;59(1):45-53.
11. Agholor K, Omo-Aghoja L, Okonofua F. Rate of negative appendectomy in pregnant women in Benin City, Nigeria. J Obstet Gynaecol Res 2011;37(11):1540-8.
12. Ito K, Ito H, Whang EE, Tavakkolizadeh A. Appendectomy in pregnancy: evaluation of the risks of a negative appendectomy. Am J Surg 2012;203(2):145-50.
13. Hiersch L, Yogev Y, Ashwal E, From A, Ben-Haroush A, Peled Y. The impact of pregnancy on the accuracy and delay in diagnosis of acute appendicitis. J Matern Fetal Neonatal Med 2014;27(13):1357-60.
14. Poletti PA, Botsikas D, Becker M, Picarra M, Rutschmann OT, Buchs NC, et al. Suspicion of appendicitis in pregnant women: emergency evaluation by sonography and low-dose CT with oral contrast. Eur Radiol 2019;29 (1):345-52.
15. Bhandari TR, Shahi S, Acharya S. Acute Appendicitis in pregnancy and the developing world. Int Sch Res Notices 2017;2017:2636759.
16. Zingone F, Sultan AA, Humes DJ, West J. Risk of acute appendicitis in and around pregnancy: a population-based cohort study from England. Ann Surg 2015;261(2):332-7.
17. Lee SH, Lee JY, Choi YY, Lee JG. Laparoscopic appendectomy versus open appendectomy for suspected appendicitis during pregnancy: a systematic review and updated meta-analysis. BMC Surg 2019;19 (1):41.
18. Cinar H, Aygun A, Derebey M, Tarim IA, Akalin C, Buyukakincak S, et al. Significance of hemogram on diagnosis of acute appendicitis during pregnancy. Ulus Travma Acil Cerrahi Derg 2018;24 (5):423-8.
19. Maslovitz S, Gutman G, Lessing JB, Kupferminc MJ, Gamzu R. The significance of clinical signs and blood indices for the diagnosis of appendicitis during pregnancy. Gynecol Obstet Invest 2003;56(4):188-91.
20. Segev L, Segev Y, Rayman S, Nissan A, Sadot E. Acute appendicitis during pregnancy: Different from the nonpregnant state? World J Surg 2017;41(1):75-81.
21. Wallace CA, Petrov MS, Soybel DI, Ferzoco SJ, Ashley SW, Tavakkolizadeh A. Influence of imaging on the negative appendectomy rate in pregnancy. J Gastrointest Surg 2008;12(1):46-50.
22. Al-Qudah MS, Amr M, Sroujieh A, Issa A. Appendectomy in pregnancy: the experience of a university hospital. J Obstet Gynaecol 1999;19(4):362-4.
23. Terzi A, Yildiz F, Vural M, Coban S, Cece H, Kaya M. A case series of 46 appendectomies during pregnancy. Wien Klin Wochenschr 2010;122(23-24):686-90.
24. Frountzas M, Nikolaou C, Stergios K, Kontzoglou K, Toutouzas K, Pergialiotis V. Is the laparoscopic approach a safe choice for the management of acute appendicitis in pregnant women? A meta-analysis of observational studies. Ann R Coll Surg Engl 2019;101(4):235-48.
25. Wilasrusmee C, Sukrat B, McEvoy M, Attia J, Thakkinstian A. Systematic review and meta-analysis of safety of laparoscopic versus open appendicectomy for suspected appendicitis in pregnancy. Br J Surg 2012;99(11):1470-8.
26. Popkin CA, Lopez PP, Cohn SM, Brown M, Lynn M. The incision of choice for pregnant women with appendicitis is through McBurney’s point. Am J Surg 2002;183(1):20-2.