Sekar Hashviniya, Rajesh Thamaran Nisha, Stoker David, Das Sayantana, Yoong Wai
Obstetrics and Gynaecology, Royal Free London NHS Foundation Trust, London, UK.
General Surgery, North Middlesex University Hospital NHS Trust, London, UK.
BMJ Case Rep. 2019 Apr 5;12(4):e228192. doi: 10.1136/bcr-2018-228192.
Our case describes a pregnant woman with acute appendicitis who presented in the third trimester and underwent a laparoscopic appendicectomy. She made a rapid postoperative recovery and the pregnancy was otherwise uncomplicated, ending with a spontaneous vaginal birth at 41 weeks. The diagnosis of acute appendicitis can be unclear in pregnancy. Difficulty in establishing diagnosis due to atypical presentation often leads to delay in surgery, resulting in significant maternal and fetal morbidity and mortality. Surgical intervention should be prompt in cases of suspected appendicitis and the laparoscopic approach is advocated in the first two trimesters. In the third trimester (after 28 weeks), laparotomy is often performed due to the size of the uterus and the theoretical risk of inadvertent perforation with trocar placement. More recently, several authors have described successful outcomes following laparoscopic appendicectomy after 28 weeks and with increasing reassuring data, we suggest that this minimally invasive approach should be considered in managing appendicitis in the third trimester.
我们的病例描述了一名患有急性阑尾炎的孕妇，她在妊娠晚期就诊并接受了腹腔镜阑尾切除术。她术后恢复迅速，妊娠过程无其他并发症，最终在41周时自然阴道分娩。妊娠期间急性阑尾炎的诊断可能不明确。由于临床表现不典型而难以确诊，常常导致手术延迟，从而造成严重的母婴发病率和死亡率。对于疑似阑尾炎的病例，应迅速进行手术干预，在前两个孕期提倡采用腹腔镜手术方法。在妊娠晚期（28周后），由于子宫大小以及套管针穿刺可能导致意外穿孔的理论风险，通常进行剖腹手术。最近，几位作者描述了28周后腹腔镜阑尾切除术后的成功结果，随着越来越多令人放心的数据出现，我们建议在处理妊娠晚期阑尾炎时应考虑这种微创方法。
