GEBELİKTE AKUT APANDİSİT OLGULARINA YAKLAŞIM; BİR DEVLET HASTANESİ PRATİĞİ

Amaç Akut apandisit, gebelikte en sık yapılan non-obstetrik cerrahidir. Gebeliğin kendine özgü fizyolojik, anatomik değişiklikleri tanı ve tedavi sürecini güçleştirir. Literatürde bu konuyla ilgili çalışmaların çoğunlukla tersiyer merkezlerin deneyimlerini yansıttığı görülmektedir. Bu çalışmanın amacı gebelikte akut apandisit vakalarına ilişkin ikinci basamak bir hizmet hastanesindeki perioperatif deneyiminin sunulmasıdır. Gereç ve Yöntem Çalışma Ocak 2015- Kasım 2020 tarihleri arasında ikinci basamak bir devlet hastanesinde retrospektif olarak yapıldı. Gebelik döneminde akut apandisit tanısı alan, postoperatif takipleri ve doğumları hastanemizde gerçekleştirilen hastalar çalışmaya alındı. Bulgular Hastaların yaş aralığı 24 yaş (18-35), ortanca gestasyonel hafta 17 hafta (8-32) idi. Ortanca lökosit sayısı 11,6 x103 uL, nötrofil sayısı 8,6 x103 uL, lenfosit sayısı 2 x103 uL, trombosit sayısı 271 x103 uL, C-reaktif protein 4,5, nötrofil/lökosit oranı 4,3, trombosit/ lenfosit oranı 120,8, lökosit/ C-reaktif protein oranı 0,7 olarak saptandı. Spinal anestezi en çok tercih edilen yöntemdi ve hastaların tamamında açık cerrahinin uygulanmış olduğu görüldü. Ortanca doğum haftası 38 idi (36-40), sadece bir hastada preterm doğumun geliştiği saptandı. Ek maternal veya fetal komplikasyon gelişmediği görüldü. Sonuç Multidisipliner yaklaşım koşuluyla ikinci basamak hizmet hastanelerinde de gebe akut apandisit’li hastalar başarıyla tedavi edilebilir.

AN APPROACH TO ACUTE APPENDICITIS CASES DURING PREGNANCY: A PUBLIC HOSPITAL PRACTICE

Objective Acute appendicitis is the most common non-obstetric surgery performed during pregnancy. Physiological and anatomical changes specific to pregnancy complicate the diagnosis and treatment processes. It has been seen in the literature that the studies on this subject mostly reflect the experiences of tertiary centers. The present study aimed to present the perioperative experience of acute appendicitis cases in pregnancy in a secondary care hospital. Materials and Methods The present study was carried out retrospectively between January 2015 and November 2020 in a secondary state hospital. Patients diagnosed with acute appendicitis during pregnancy and whose postoperative follow-ups and labors were carried out in our hospital were included in the study. Results The median age of the patients was 24 years (18- 35), the median gestational week was 17 weeks (8- 32). The median leukocyte count was 11.6 x103 uL, neutrophil count was 8.6 x103 uL, lymphocyte count was 2 x103 uL, thrombocyte count was 271 x x103 uL, C-reaktif protein was 4.5, neutrophil/ leukocyte ratio was 4.3, thrombocyte/lymphocyte was ratio 120.8, and the leukocyte /C-reaktif protein ratio was 0.7. Spinal anesthesia was the most preferred method and it was observed that open surgery was performed in all patients. The median week of delivery was 38 (36- 40) and preterm labor was seen in only one patient. It was observed that no additional maternal or fetal complications developed. Conclusion Pregnant acute appendicitis patients can also be successfully treated in secondary service hospitals on the condition of a multidisciplinary approach.

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