Appendicitis in pregnancy: Experience of thirty-eight patients diagnosed and managed at a tertiary care hospital in Karachi
Objective: To evaluate the clinical presentation, diagnosis, management, and outcome of acute appendicitis complicating pregnancy at a tertiary care hospital in Karachi. Materials and methods: This was a retrospective analytical case note review of all patients clinically diagnosed with acute appendicitis during pregnancy at the Aga Khan University Hospital (AKUH), Karachi from January 01, 1990 to July 31, 2006. Results: During the review period, 38 pregnant patients were diagnosed with acute appendicitis; a total of 43,134 deliveries took place in the maternity department of the hospital during the same period. The mean age at presentation was 26 years and 66% of patients were multigravida. Thirty percent were in the 1st trimester, 37% in 2nd trimester, and 34% in the 3rd trimester. Abdominal pain was the chief complaint in all patients with the right lower quadrant being the commonest site (74%). Tenderness on physical examination was also mainly located in the same area (87%). Eighty-two percent patients had leukocytosis at presentation. An abdominal and pelvic ultrasound identified an inflamed appendix in 39%. Appendectomy was performed in 37 (97%) cases. One patient was managed conservatively. Thirty-five (95%) had an inflamed appendix on histology. Two patients were found to have a normal appendix, though one of these had an inflamed Meckel's diverticulum. Six (16%) patients developed postoperative complications; of these wound infection and pulmonary embolism were the most common and significant. Adequate deep venous thrombosis (DVT) prophylaxis with heparin was given in 8 (21%) patients. Preterm contractions developed in 5 (13%) patients and 3 (8%) patients had preterm delivery. There was no maternal mortality; however one fetal death was noted. Conclusion: Timely diagnosis of acute appendicitis in pregnancy can be difficult. In most cases a correct diagnosis can be arrived at on the basis of a history and physical examination with supportive routine laboratory tests. Urgent surgery is the treatment of choice but delay continues to be a common problem. Infective complications are well recognized in appendicitis; similarly this group of patients is at a higher risk of venous thrombosis and embolism, and routine prophylaxis should be considered in all.