Department of Surgery, University of British Columbia, 2775 Laurel Street 11th Floor, Vancouver, BC, V5Z 1M9, Canada.
Department of Radiology, Providence Healthcare, St. Paul's Hospital, Vancouver, BC, V6Z 1Y6, Canada.
Am J Surg. 2020 May;219(5):855-859. doi: 10.1016/j.amjsurg.2020.03.018. Epub 2020 Mar 26.
The diagnosis of acute appendicitis (AA) in pregnancy remains challenging. We investigated which preoperative clinical factors are most predictive of AA in pregnant women.
164 pregnant patients undergoing magnetic resonance imaging for suspected AA were retrospectively reviewed. Logistic regression was used to compare those with pathologically confirmed AA and those without.
28 patients (17.1%) had pathologically confirmed AA. 42.9% (n = 12) were perforated at the time of operation. Factors associated with AA included history of emesis (p = 0.005), migratory abdominal pain (p = 0.006), rebound tenderness (p = 0.01), elevated white blood cell count (p = 0.003), elevated Alvarado Score (p < 0.001), elevated neutrophil count (p = 0.021), and left shift (p = 0.001). As a screening test, a left shift with neutrophils >70% provided a sensitivity and negative predictive value of 100.0%.
Every patient in our series with AA had a left shift. Neutrophil count and percentage should be considered in the diagnostic evaluation of these patients to better guide resource utilization and treatment.
妊娠合并急性阑尾炎（AA）的诊断仍然具有挑战性。我们研究了哪些术前临床因素对孕妇 AA 最具预测性。
回顾性分析了 164 例因疑似 AA 而行磁共振成像检查的孕妇。采用逻辑回归比较病理证实为 AA 组和非 AA 组。
28 例（17.1%）患者经病理证实为 AA。术中穿孔者占 42.9%（n=12）。与 AA 相关的因素包括呕吐史（p=0.005）、转移性腹痛（p=0.006）、反跳痛（p=0.01）、白细胞计数升高（p=0.003）、Alvarado 评分升高（p<0.001）、中性粒细胞计数升高（p=0.021）和左移（p=0.001）。作为一种筛查试验，左移伴中性粒细胞>70%的敏感性和阴性预测值均为 100.0%。
我们研究中的每例 AA 患者均有左移。在这些患者的诊断评估中应考虑中性粒细胞计数和百分比，以更好地指导资源利用和治疗。
