Department of Surgery, University Medical Center Groningen (UMCG), Hanzeplein 1, 9700 RB Groningen, The Netherlands.
Department of Gynaecology and Obstetrics, University Medical Center Groningen (UMCG), Hanzeplein 1, 9700 RB Groningen, The Netherlands.
Int J Surg. 2015 Mar;15:84-9. doi: 10.1016/j.ijsu.2015.01.025. Epub 2015 Jan 29.
Acute appendicitis during pregnancy may be associated with serious maternal and/or fetal complications. To date, the optimal clinical approach to the management of pregnant women suspected of having acute appendicitis is subject to debate. The purpose of this retrospective study was to provide recommendations for prospective clinical management of pregnant patients with suspected appendicitis.
Case records of all pregnant patients suspected of having appendicitis whom underwent appendectomy at our hospital between 1990 and 2010 were reviewed.
Appendicitis was histologically verified in fifteen of twenty-one pregnant women, of whom six were diagnosed with perforated appendicitis. Maternal morbidity was seen in two cases. Premature delivery occurred in two out of six cases with perforated appendicitis cases and two out of six cases following a negative appendectomy. Perinatal mortality did not occur.
Both (perforated) appendicitis and negative appendectomy during pregnancy are associated with a high risk of premature delivery. Clinical presentation and imaging remains vital in deciding whether surgical intervention is indicated. We recommend to cautiously weigh the risks of delay until correct diagnosis with associated increased risk of appendiceal perforation and the risk of unnecessary surgical intervention. Based upon current literature, we recommend clinicians to consider an MRI following an inconclusive or negative abdominal ultrasound aiming to improve diagnostic accuracy to reduce the rate of negative appendectomies. Accurate and prompt diagnosis of acute appendicitis should be strived for to avoid unnecessary exploration and to aim for timely surgical intervention in pregnant women suspected of having appendicitis.
孕妇急性阑尾炎可能会引起严重的母婴并发症。迄今为止，对于疑似患有急性阑尾炎的孕妇，其最佳的临床处理方法仍存在争议。本回顾性研究旨在为疑似阑尾炎的孕妇提供前瞻性临床处理建议。
回顾分析了我院 1990 年至 2010 年间接受阑尾切除术的 21 例疑似阑尾炎的孕妇病例记录。
在 21 例疑似阑尾炎的孕妇中，有 15 例经组织学检查确诊为阑尾炎，其中 6 例为穿孔性阑尾炎。有 2 例发生了母体并发症。在 6 例穿孔性阑尾炎中，有 2 例发生早产，在 6 例阴性阑尾切除术后也发生了 2 例早产。未发生围产期死亡。
无论是（穿孔性）阑尾炎还是阴性阑尾切除术，在怀孕期间都与早产风险增加相关。临床症状和影像学检查在决定是否需要手术干预方面至关重要。我们建议谨慎权衡延迟诊断的风险，以避免阑尾穿孔的风险增加，以及不必要的手术干预的风险。基于当前的文献，我们建议临床医生在腹部超声检查结果不确定或阴性时考虑进行 MRI，以提高诊断准确性，从而降低阴性阑尾切除术的发生率。应努力准确和及时地诊断急性阑尾炎，以避免不必要的探查，并在疑似阑尾炎的孕妇中争取及时进行手术干预。
