Pregnancy and appendicitis symptoms

Diagnosis of appendicitis in pregnancy is difficult for several reasons. An enlarging uterus can alter the position of the appendix, which may even show up in the right upper quadrant. And loss of abdominal-wall elasticity can change presenting signs. In addition, a perforated appendix is less likely to be contained by omentum and more likely to result in generalized peritonitis.

Appendicitis is the most common cause of acute abdomen in pregnant patients and thus the most common nongynecologic surgery performed in any trimester. Ultrasound and CT are especially useful in detecting or excluding appendicitis in pregnant women. A recent study showed negative appendectomy rates with clinical evaluation alone to be 54% (7/13), with ultrasound 36% (20/55), and with ultrasound followed by CT scan 8% (1/13). The authors recommend ultrasound, followed by CT scan in patients with normal or inconclusive ultrasounds.

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