Appendicitis in pregnancy, higher rate of perforation compared to nonpregnant patients

To compare clinical presentation and diagnostic evaluation to identify differences in treatment between pregnant and nonpregnant patients with appendicitis.

Retrospective case-control study comparing 12 pregnant and 60 nonpregnant, age-matched patients who had an appendectomy for acute appendicitis (pathology confirmed) between January 1, 2011 and June 30, 2019. We compared maternal characteristics, laboratory test results, physical examination findings, diagnostic work-up, surgical modality, and surgical outcomes.

There was no difference in symptom profile and pain intensity at presentation between groups. More pregnant patients had right upper quadrant tenderness (83.3% vs. 31 %, p=0.03) and were more likely to have more than one imaging diagnostic modality (75% vs. 15 %, p<0.01). In nonpregnant patients, computed tomography was the main diagnostic modality (90 %) whereas there was more variation in imaging for pregnant patients. For pregnant patients, time from presentation to surgery (20.0 ± 11.8 h vs. 9.9 ± 4.9 h; p=0.01) and time from presentation to receipt of antibiotics (14.5 ± 12.0 h vs. 5.9 ± 3.2 h, p<0.01) were twice that of nonpregnant patients. Surgery duration was similar between groups (pregnant: 54.8 ± 31.3 min vs. nonpregnant: 45.6 ± 19.5 min, p=0.34). All nonpregnant patients underwent laparoscopic appendectomy. Seven pregnant patients underwent laparoscopy, three had laparotomy, and two began with laparoscopy that was converted to laparotomy. More pregnant patients perforated (25 % vs. 3.3 %, p=0.03).

Despite having similar presentations, it took twice as long to treat pregnant patients with antibiotics and perform an appendectomy. More perforations occurred in pregnant patients compared to nonpregnant patients.