AppendicitisDuringPregnancy
Appendicitis During Pregnancy
EpidemiologyAnatomicalchangesPathophysiologyComplicationsDiagnosisODDSurgeryConclusion
❑Epidemiology ❑Anatomical changes ❑Pathophysiology ❑Complications ❑Diagnosis ❑DD ❑Surgery ❑Conclusion
EpidemiologyLifetime occurrence of 7%Peak incidence: 10-30yThe most common cause of acute abdomen inpregnancy non-obstetric surgical interventionduring pregnancy {Accounts for 25%)Suspected in:1in1000pregnantwomen(MazzeandKallen,1991)Confirmedin:65%
Epidemiology ✓ Lifetime occurrence of 7% Peak incidence: 10-30y ✓ The most common cause of acute abdomen in pregnancy non-obstetric surgical intervention during pregnancy {Accounts for 25%} ✓ Suspected in: 1 in 1000 pregnant women (Mazze and Källén, 1991) Confirmed in: 65%
Incidence:1in1500pregnanciesReduced during pregnancy, especially in 3rd T(Protective effect of pregnancy?](Andersson &Lambe,2001)Same (Some studies)·Equal in all three trimesters: 1st T: 30% 2nd T: 45% 3rd: 25%
❑ Incidence: 1 in 1500 pregnancies Reduced during pregnancy, especially in 3rd T {Protective effect of pregnancy?} (Andersson &Lambe, 2001). Same (Some studies) • Equal in all three trimesters. • 1 st T: 30% • 2 nd T: 45% • 3 rd: 25%
AnatomicalchangesduringpregnancyI. Position of appendix:Gravid uterus →displacement upward &outward(Baeretal,1932,manyauthors)No change in location (Mourad et al, 2000; Hodjatiet al,2003)Degree of displacement, if any, is likely due todifferingextentofcecalfixation
Anatomical changes during pregnancy I. Position of appendix: Gravid uterus → displacement upward & outward (Baer et al, 1932, many authors) No change in location (Mourad et al, 2000; Hodjati et al ,2003) Degree of displacement, if any, is likely due to differing extent of cecal fixation
Position of Appendix(Baeret al, 1932)12 W: McBurney's point24 W: lliac crest36W:RUQ
Position of Appendix (Baer et al, 1932) 12 W: McBurney’s point 24 W: Iliac crest 36 W: RUQ
Il. Gravid Uterus:The uterus enlarges 20 times:1. Stretching of supporting ligaments & muscles2.Pressure on intra-abdominal structures & ant abdwall, prevents irritation of ant abd wall by inflamedintra-abdominalorgans→>decreasedperceptionofsomaticpain&localization3.Obstructs &inhibitsthe movement ofthe omentum(policeman of the abdomen): prevents omentumfromlocalizinginfection
II. Gravid Uterus: The uterus enlarges 20 times: 1. Stretching of supporting ligaments & muscles. 2. Pressure on intra-abdominal structures & ant abd wall, prevents irritation of ant abd wall by inflamed intra-abdominal organs → decreased perception of somatic pain & localization 3. Obstructs & inhibits the movement of the omentum (policeman of the abdomen): prevents omentum from localizing infection
InflammationPathophysiologyIntraluminal PressureLymphoid SwellingAppendicitis:Decreased Venous DrainageThrombosisBacterialInvasioninflammation of thevermiformappendixAbscesscaused byan obstructionattributable to infectionGangrenestructure,fecal massforeign body, or tumorPerforation (24 to 36 hours)Penitonitis
Appendicitis: inflammation of the vermiform appendix caused by an obstruction attributable to infection, structure, fecal mass, foreign body, or tumor Pathophysiology
ComplicationsIncreased with increasing gestational agedelay indiagnosis
Complications ❑ Increased with increasing gestational age. delay in diagnosis
1. Abortion: 15%2. Fetal loss: 1.5-5.1%3. Preterm labor:13-22%3rd TPerforated appendix & peritonitis1st week after surgery
1. Abortion: 15% 2. Fetal loss: 1.5-5.1% 3. Preterm labor: 13-22% 3 rd T Perforated appendix & peritonitis 1st week after surgery