Appendicitis in pregnancy: how to avoid misdiagnosis and diagnostic delay

  • Schwulst SJ & al.
  • JAMA
  • 1 Jul 2019

  • International Clinical Digest
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Takeaway

  • 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. 

Key guidance

  • 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.