Diagnostic delays and a high negative laparotomy rate continue to complicate acute appendicitis in pregnant patients, according to a retrospective case series.
Researchers evaluated nine pregnant women diagnosed with the condition at James Cook University Hospital in Middlesbrough, United Kingdom, between July 2017 and July 2024. The mean age of the patients in the cohort was 26.6 years, with cases occurring during the first trimester in one patient (11.1%), the second trimester in three patients (33.3%), the third trimester in four patients (44.4%), and the postpartum period in one patient (11.1%).
Right iliac fossa pain was reported as the most common presentation, and white blood cell counts alongside C-reactive protein levels were elevated in all cases.
The study analyzed clinical presentations, diagnostic imaging performance, and surgical outcomes across a seven-year period. Anatomical and physiological changes during gestation often obscure classical symptoms like right iliac fossa pain, making timely identification difficult for clinical teams.
Diagnostic modalities showed varying degrees of reliability during the evaluation window. Imaging was utilized to support the diagnosis in seven of the nine patients, accounting for 77.8% of the cohort. Ultrasound examinations were performed in five patients (55.6%), yielding just one positive result (20.0%), one inconclusive finding (20.0%), and three false-negative outcomes (60.0%). Computed tomography was performed in one patient (11.1%).
Magnetic resonance imaging demonstrated superior diagnostic performance compared to ultrasound. Seven patients underwent MRI (77.8%), which successfully identified appendicitis in all clinically suspected cases, though two examinations were subsequently classed as false-positives.
All nine patients (100%) ultimately required surgical intervention after initial treatment with intravenous antibiotics. The mean time interval from hospital presentation to surgery stretched to 3.4 days, driven in part by initial diagnostic uncertainty and reluctance to operate.
Surgeons performed six laparoscopic appendicectomies (66.7%) and three open procedures (33.3%). Histopathological examination confirmed acute appendicitis in five of the nine cases (55.6%), resulting in a negative appendicectomy rate of 44.4 percent.
Patients with confirmed acute appendicitis experienced complications during their hospital stays. Five individuals developed local or generalized peritonitis (55.6%), two suffered sepsis (22.2%), one experienced appendiceal perforation (11.1%), and one suffered preterm labor (11.1%).
Multidisciplinary collaboration between obstetricians, general surgeons, and anaesthetists remains essential for managing acute abdominal pain during pregnancy. Investigators noted that neither maternal nor neonatal mortality occurred within this specific patient cohort.
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