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Pregnancy and Appendicitis

Appendicitis is the most common non obstetric cause of surgical emergency in pregnancy.
The incidence is 0.02 to 0.05%.
Pregnancy does not affect the overall incidence of appendicitis, but the severity may be increased in pregnancy. Appendicitis seems to be more common in the second trimester.

Signs include the following:
* Pain is located in right lower quadrant in the first trimester. In the second trimester, the appendix is located at the level of the umbilicus. Pain is diffuse or in the right upper quadrant in the third trimester.
* Anorexia
* Vomiting
* Nausea
* Pain migration
* Fever

Ultrasonography
Criteria for ultrasound diagnosis of appendicitis are :
1. non-compressible aperistaltic sausage appendix with wall thickening. Ultrasound findings in non-perforated appendicitis include a muscular wall thickness greater than 2 mm, an appendicial diameter (outer wall to outer wall) greater than 7 mm that does not compress, a "target" sign (bull's-eye appearance) of abnormally thickened bowel wall layers when viewed in the short axis, and sometimes distension or obstruction of the appendicial lumen accompanied by increased echogenicity "oedema" surrounding the appendix. Findings may also include Doppler in the wall of the appendix, indicating increased appendicial perfusion.
2. démonstration of an appendicolith, which is seen as an echogenic focus within the appendix lumen with shadowing. Further signs include fluid around the appendix, an inflammatory bowel mass and the formation of abscess.

Differential :
* Ectopic pregnancy
* Large corpus luteun cyst (> 5 cm)
* Adnexal torsion (torsion of ovary)
* ovarian neoplasm
* degeneration of fibroids
* Pelvic inflammatory (tubo-ovarian abscess)
* Round ligament pain
Cause unrelated to pregnancy :
* Renal stone
* diverticular abscess
* Gastroenteritis
* Pancreatitis * Cholecystitis
* Mesenteric adenitis
* Hernia
* Bowel obstruction

Treatment :
Treatment of appendicitis is surgical.

Prognosis :
Perforation and abscess formation are more likely to occur in pregnant patients with appendicitis than in non pregnant patients with appendicitis. Any increase in severity later in pregnancy may be due to a delay in diagnosis.