ACUTE APPENDICITIS IN PREGNANCY- CLINICAL FEATURES, DIAGNOSTIC MODALITIES AND MANAGEMENT

BACKGROUND Acute appendicitis is the most common non-obstetric surgical emergency during pregnancy accounting for 1 in 1500 deliveries with preponderance during the second trimester. Attention of the surgeons is often distracted by the pregnant status and requires a high index of suspicion in a labouring patient with less prominent peritoneal findings and atypical laboratory values. With the objective of determining the presenting features, imaging confirmation and appropriate management, a study is conducted on appendicitis during pregnancy. MATERIALS AND METHODS A descriptive study was carried out in the Department of Surgery, Regional Institute of Medical Sciences (RIMS), Imphal, Manipur, for a period of 2 years from September 2015 to August 2017 on 17 patients admitted with acute appendicitis during pregnancy under variables including age, weeks of pregnancy, symptoms, duration, presenting signs, palpable mass, total leucocyte count, ultrasound findings, treatment received, outcome, length of stay and histopathological findings. Continuous measurements were presented on Mean +/- SD (Min - Max) and results on categorical measurements were presented in number (%). SPSS version 21 was used for the analysis. RESULTS Age group of 18 - 29 years (76.5%) with the mean 26.88 +/- 5.28 was most affected; 82.4% were urban middle class, 58.8% during the second trimester followed by first (29.4%) and third (11.8%) trimester respectively. Right Iliac Fossa (RIF) tenderness was present in 16 patients (94.1%), rebound tenderness in 11 patients (64.7%) and 6 patients (35.3%) underwent appendicectomy. The hospital stay of the patients was of mean duration of 5.65 +/- 1.7 days. CONCLUSION Acute appendicitis in pregnancy remains a challenge to the evaluating surgeon. The potential hazard of the ionising radiation limits the choices of imaging during pregnancy. Even though ultrasonography has proven to be accurate in the first and second trimester, sensitivity is less and it is technically difficult to perform in the late second and third trimester. Further, judicious imaging (CT/MRI) may avoid a negative appendicectomy but carries significant maternal and foetal morbidity. Early diagnosis and surgical intervention reduce the morbidity and mortality from the disease.