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Acute appendicitis during pregnancy: differences in clinical presentation, management, and outcome

Tinoco-González J, Rubio-Manzanares-Dorado M, Senent-Boza A, Durán-Muñoz-Cruzado V, Tallón-Aguilar L, Pareja-Ciuró F, Padillo-Ruíz J

Unidad de Cirugía de Urgencias, Hospital Virgen del Rocío. Hospital General, Sevilla, Spain. Servicio de Cirugía General y del Aparato Digestivo, Hospital Virgen del Rocío. Hospital General, Sevilla, Spain. Facultad de Medicina de la Universidad de Sevilla.

Objective. To analyze the clinical presentation, management, and outcome of acute appendicitis (AA) in pregnant and nonpregnant women of childbearing age.
Methods. Descriptive study of 2 cohorts of women (pregnant –P– and nonpregnant –NP–). The women, who were matched according to risk factors, were included when they underwent an emergency appendectomy based on clinical
suspicion of AA. We recorded age, medical history, clinical presentation, management, and outcome. Pregnant women were classified according to gestational age of the fetus (trimester).
Results. We included 153 women (51 P, 102 NP). The mean (SD) age was 28.8 (6.5) years (P women, 29.7 [5.8] years; NP, 28.3 [6.8]; P=.242). The mean Alvarado score was 7.1 (1.6) (P, 6.7 [1.7]; NP, 7.3 [1.5]; P=.016). The rate of complicated AA was higher in P (19.6%) than NP (2.9%) women (P<.001). Pregnancy was also associated with
higher rates of surgical wound infection (P, 14.0%; NP, 3.0%; P=.016) and a longer mean hospital stay (P, 5.1 [4.8] days; NP, 1.7 [1.0]; P<.001). In the third trimester of P, poorer outcomes were recorded in relation to these risks (P=.031; P=.003, and P<.001, respectively).
Conclusions. The atypical clinical presentation of AA during pregnancy makes diagnosis difficult and may lead to a higher incidence of complicated AA and surgical wound infection as well as longer hospital stays, particularly when AA presents in the third trimester.

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