- When a patient presents with abdominal pain during pregnancy, diagnosing appendicitis can be challenging.
- These authors offer guidance on diagnostic imaging in this population, which has a higher likelihood of nonclassic symptoms.
Why this matters
- Anatomic and physiological changes of pregnancy can complicate appendicitis diagnosis.
- Delayed diagnosis and misdiagnosis are both risks: perforated appendix and negative appendectomy are the major risk factors in fetal loss associated with appendicitis.
- An included imaging algorithm for abdominal pain in pregnancy is based on this publication .
- Ultrasonography obviously involves no radiation exposure, but its sensitivity for appendicitis in pregnancy is 31.8%-83.9%, and its specificity is 56.7%-96.7%; it visualizes a normal appendix in only 1 in 50 pregnant patients.
- With inconclusive ultrasound, MRI can be used without radiation risk, with a sensitivity of 84%-99% and specificity of 77%-97%, both depending on reader expertise.
- If MRI is inconclusive or unavailable, CT scan, to be done “without delay” (no harmful effects with total fetal exposure
- Trials of antibiotics in lieu of surgery have excluded pregnant patients, so these authors say that appendectomy remains the resolution if appendicitis is diagnosed.