Acute Appendicitis

  • Goran Augustin


Acute appendicitis is the most common nonobstetric operative emergency during pregnancy. It amounts to 25% of operative indications for the acute abdomen during pregnancy and puerperium. Pain in the right lower quadrant is the most reliable symptom, and abdominal tenderness is almost always present. Fever and tachycardia are not sensitive signs. Leukocytosis is not diagnostic because elevated levels are found during pregnancy and especially in the early labor in normal pregnancy. Neutrophil granulocytosis is diagnostic as it is a sign of bacterial infection. Graded abdominal ultrasound is the diagnostic procedure of choice with less accuracy in the third trimester with no guidelines about the use of transvaginal ultrasound. Magnetic resonance imaging is the diagnostic procedure of choice in cases when abdominal ultrasound is not diagnostic. Management is always surgical, either by open approach or laparoscopy. Fetal mortality in uncomplicated appendicitis is low and rises several times when perforation and diffuse peritonitis develop. Maternal mortality is almost 0% and rises with the delay in surgery for more than 24 h which is the most common situation in the third trimester when the diagnosis is the most difficult.


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Goran Augustin
    • 1
    • 2
  1. 1.School of Medicine University of ZagrebZagrebCroatia
  2. 2.Department of SurgeryUniversity Hospital Centre ZagrebZagrebCroatia

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