Scholars Bulletin (SB)
Volume-5 | Issue-07 | Sch Bull, 2019; 5(7): 356-361
Research Article
Appendicitis in Pregnant Women, Place of laparoscopy: Retrospective Study of 15 Cases
Elloumi Habib, Ben Slima M, Lassoued I
Published : July 30, 2019
Abstract
Introduction: Acute appendicitis is the surgical emergency that occurs most often in pregnant women with a prevalence of 0.05 to 0.1%. It is a clinical entity that gives in to diagnostic problems. The treatment of appendicitis in pregnant women is surgical. The use of the laparoscopic route depends mainly on the age of pregnancy, the location of the appendix and the presence of complications. The prognosis is maternal and fetal and the mortality varies from 0.5 to 1.5%. Material and Methods: This is a retrospective study of 15 cases treated in the general surgery department B of the Rabta hospital from 2011 to 2018. Results: This is a series of 15 patients whose average age was 27 years with extremes of 20 and 39 years. Among our patients, 2 had a caesarean section median, 2 had a right subcostal for cholecystectomy, and one patient had a umbilical hernia plate replacement. The age of pregnancy was in the 2nd trimester in 8 patients. The duration of evolution of the symptomatology was on average 2 days. Pain in the right iliac fossa was present in 8 patients. A fever was observed in 2 patients. Vomiting was noted in 6 patients. A biological inflammatory syndrome was present in 7 patients. Abdominal ultrasonography, performed in 10 patients, made it possible to retain the diagnosis in 6 patients. Tocolysis was performed in all cases. The appendectomy was performed laparoscopically in 9 patients. Seven of them had a term less than 20 SA. The least advanced pregnancy was 8 SA and the most advanced 24 SA. The Mac Burney pathway was performed in 5 patients and one patient was operated on by median laparotomy. The appendix was inflammatory in 2 patients, phlegmonous in 5 patients, gangrenous in 4 patients and perforated in 4 patients including an appendiceal abscess in 3 cases and peritonitis in one case. Drainage was performed in 4 patients. The postoperative courses were marked by a wall abscess in 3 patients, Premature delivery for one and a spontaneous abortion for one. Conclusion: Acute appendicitis in pregnant women is a diagnostic problem mainly in the 2nd and 3rd trimesters of pregnancy. The laparoscopic approach has been described at any age of pregnancy, but it is far from being considered a gold standard for appendicitis in pregnant women; studies are underway to assess the long-term course of children whose mothers have had laparoscopic appendectomy.