Abstract
Amaç
Akut apandisit, gebelikte en sık yapılan non-obstetrik
cerrahidir. Gebeliğin kendine özgü fizyolojik, anatomik
değişiklikleri tanı ve tedavi sürecini güçleştirir. Literatürde
bu konuyla ilgili çalışmaların çoğunlukla tersiyer
merkezlerin deneyimlerini yansıttığı görülmektedir. Bu
çalışmanın amacı gebelikte akut apandisit vakalarına
ilişkin ikinci basamak bir hizmet hastanesindeki perioperatif
deneyiminin sunulmasıdır.
Gereç ve Yöntem
Çalışma Ocak 2015- Kasım 2020 tarihleri arasında
ikinci basamak bir devlet hastanesinde retrospektif
olarak yapıldı. Gebelik döneminde akut apandisit tanısı
alan, postoperatif takipleri ve doğumları hastanemizde
gerçekleştirilen hastalar çalışmaya alındı.
Bulgular
Hastaların yaş aralığı 24 yaş (18-35), ortanca gestasyonel
hafta 17 hafta (8-32) idi. Ortanca lökosit sayısı
11,6 x103 uL, nötrofil sayısı 8,6 x103 uL, lenfosit sayısı
2 x103 uL, trombosit sayısı 271 x103 uL, C-reaktif
protein 4,5, nötrofil/lökosit oranı 4,3, trombosit/ lenfosit
oranı 120,8, lökosit/ C-reaktif protein oranı 0,7
olarak saptandı. Spinal anestezi en çok tercih edilen
yöntemdi ve hastaların tamamında açık cerrahinin uygulanmış
olduğu görüldü. Ortanca doğum haftası 38
idi (36-40), sadece bir hastada preterm doğumun geliştiği
saptandı. Ek maternal veya fetal komplikasyon
gelişmediği görüldü.
Sonuç
Multidisipliner yaklaşım koşuluyla ikinci basamak hizmet
hastanelerinde de gebe akut apandisit’li hastalar
başarıyla tedavi edilebilir.
References
- Zingone F, Sultan AA, Humes DJ, West J. Risk of acute appendicitis in and around pregnancy: a population-based cohort study from England. Ann Surg. 2015;261(2):332-7.
- Franca Neto AHd, Amorim MMRd, Nóbrega BMSV. Apendicite aguda na gestação: revisão de literatura. Rev Assoc Med Bras. 2015;61(2):170-7.
- Sanci M, Töz E, Ince O, Özcan A, Polater K, Inan AH, et al. Reference values for maternal total and differential leukocyte counts in different trimesters of pregnancy and the initial postpartum period in western Turkey. J Obstet Gynaecol. 2017;37(5):571-5.
- Moreno CC, Mittal PK, Miller FH. Nonfetal Imaging During Pregnancy: Acute Abdomen/Pelvis. Radiol Clin North Am. 2020;58(2):363-80.
- Masselli G, Derme M, Laghi F, Framarino-dei-Malatesta M, Gualdi G. Evaluating the acute abdomen in the pregnant patient. Radiol Clin North Am. 2015;53(6):1309-25.
- Liu J, Ahmad M, Wu J, Tong XJ, Zeng HZ, Chan FSY, et al. Antibiotic is a safe and feasible option for uncomplicated appendicitis in pregnancy‐A retrospective cohort study. Asian J Endosc Surg. 2020.
- Lee SH, Lee JY, Choi YY, Lee JG. Laparoscopic appendectomy versus open appendectomy for suspected appendicitis during pregnancy: a systematic review and updated meta-analysis. BMC surg. 2019;19(1):41.
- McGory ML, Zingmond DS, Tillou A, Hiatt JR, Ko CY, Cryer HM. Negative appendectomy in pregnant women is associated with a substantial risk of fetal loss. J Am Coll Surg. 2007;205(4):534-40.
- Vujic J, Marsoner K, Lipp-Pump A, Klaritsch P, Mischinger H, Kornprat P. Non-obstetric surgery during pregnancy–an eleven-year retrospective analysis. BMC Pregnancy Childbirth. 2019;19(1):382.
- Dindo D, Demartines N, Clavien P-A. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205.
- Akbas A, Aydin Kasap Z, Hacim NA, Tokocin M, Altinel Y, Yigitbas H, et al. The value of inflammatory markers in diagnosing acute appendicitis in pregnant patients. Ulus Travma Acil Cerrahi Derg. 2020;26(5):769-76.
- Çınar H, Aygün A, Derebey M, Tarım İA, Akalın Ç, Büyükakıncak S, et al. Significance of hemogram on diagnosis of acute appendicitis during pregnancy. Ulus Travma Acil Cerrahi Derg. 2018;24(5):423-8.
- Mei Z, Li H, Serdula MK, Flores‐Ayala RC, Wang L, Liu JM, et al. C‐reactive protein increases with gestational age during pregnancy among Chinese women. Am J Hum Biol. 2016;28(4):574-9.
- Patel D, Fingard J, Winters S, Low G. Clinical use of MRI for the evaluation of acute appendicitis during pregnancy. Abdom Radiol. 2017;42(7):1857-63.
- Duke E, Kalb B, Arif-Tiwari H, Daye ZJ, Gilbertson-Dahdal D, Keim SM, et al. A systematic review and meta-analysis of diagnostic performance of MRI for evaluation of acute appendicitis. AJR Am J Roentgenol. 2016;206(3):508-17.
- Yoon I, Slesinger TL. Radiation Exposure In Pregnancy. 2019.
- Practice CoO. Committee opinion No. 723: guidelines for diagnostic imaging during pregnancy and lactation. Obstet Gynecol. 2017;130(4):e210.
- Mantoglu B, Altintoprak F, Firat N, Gonullu E, Dikicier E, Akdeniz Y, et al. Reasons for Undesirable Pregnancy Outcomes among Women with Appendicitis: The Experience of a Tertiary Center. Emerg Med Int. 2020;2020.
- Şenocak R, Çelik Su, Kaymak Ş. Diagnosis, Management And Clinicopathological Features Of Acute Appendicitis In Pregnant Women And Its Impact On Fetal Outcomes. İstanbul Tıp Fakültesi Dergisi.135-40.
- Ibiebele I, Schnitzler M, Nippita T, Ford JB. Appendicectomy during pregnancy and the risk of preterm birth: a population data linkage study. Aust N Z J Obstet Gynaecol. 2019;59(1):45-53.
- Frountzas M, Nikolaou C, Stergios K, Kontzoglou K, Toutouzas K, Pergialiotis V. Is the laparoscopic approach a safe choice for the management of acute appendicitis in pregnant women? A meta-analysis of observational studies. Ann R Coll Surg Engl. 2019;101(4):235-48.
- Yumi H. Guidelines for diagnosis, treatment, and use of laparoscopy for surgical problems during pregnancy. Surg Endosc. 2008;22(4):849-61.
- Salminen P, Tuominen R, Paajanen H, Rautio T, Nordström P, Aarnio M, et al. Five-year follow-up of antibiotic therapy for uncomplicated acute appendicitis in the APPAC randomized clinical trial. JAMA. 2018;320(12):1259-65.
- Kuczkowski KM. Nonobstetric surgery during pregnancy: what are the risks of anesthesia? Obstet Gynecol Surv. 2004;59(1):52-6.
- Olutoye OA, Baker BW, Belfort MA. FDA Warning on Anesthesia and Brain Development: Am J Obstet Gynecol. 2018;218(1):98-102.
Abstract
Objective
Acute appendicitis is the most common non-obstetric
surgery performed during pregnancy. Physiological
and anatomical changes specific to pregnancy
complicate the diagnosis and treatment processes.
It has been seen in the literature that the studies on
this subject mostly reflect the experiences of tertiary
centers. The present study aimed to present the
perioperative experience of acute appendicitis cases
in pregnancy in a secondary care hospital.
Materials and Methods
The present study was carried out retrospectively
between January 2015 and November 2020 in a
secondary state hospital. Patients diagnosed with
acute appendicitis during pregnancy and whose
postoperative follow-ups and labors were carried out
in our hospital were included in the study.
Results
The median age of the patients was 24 years (18-
35), the median gestational week was 17 weeks (8-
32). The median leukocyte count was 11.6 x103 uL,
neutrophil count was 8.6 x103 uL, lymphocyte count
was 2 x103 uL, thrombocyte count was 271 x x103 uL,
C-reaktif protein was 4.5, neutrophil/ leukocyte ratio
was 4.3, thrombocyte/lymphocyte was ratio 120.8,
and the leukocyte /C-reaktif protein ratio was 0.7.
Spinal anesthesia was the most preferred method and
it was observed that open surgery was performed in
all patients. The median week of delivery was 38 (36-
40) and preterm labor was seen in only one patient.
It was observed that no additional maternal or fetal
complications developed.
Conclusion
Pregnant acute appendicitis patients can also be
successfully treated in secondary service hospitals on
the condition of a multidisciplinary approach.
References
- Zingone F, Sultan AA, Humes DJ, West J. Risk of acute appendicitis in and around pregnancy: a population-based cohort study from England. Ann Surg. 2015;261(2):332-7.
- Franca Neto AHd, Amorim MMRd, Nóbrega BMSV. Apendicite aguda na gestação: revisão de literatura. Rev Assoc Med Bras. 2015;61(2):170-7.
- Sanci M, Töz E, Ince O, Özcan A, Polater K, Inan AH, et al. Reference values for maternal total and differential leukocyte counts in different trimesters of pregnancy and the initial postpartum period in western Turkey. J Obstet Gynaecol. 2017;37(5):571-5.
- Moreno CC, Mittal PK, Miller FH. Nonfetal Imaging During Pregnancy: Acute Abdomen/Pelvis. Radiol Clin North Am. 2020;58(2):363-80.
- Masselli G, Derme M, Laghi F, Framarino-dei-Malatesta M, Gualdi G. Evaluating the acute abdomen in the pregnant patient. Radiol Clin North Am. 2015;53(6):1309-25.
- Liu J, Ahmad M, Wu J, Tong XJ, Zeng HZ, Chan FSY, et al. Antibiotic is a safe and feasible option for uncomplicated appendicitis in pregnancy‐A retrospective cohort study. Asian J Endosc Surg. 2020.
- Lee SH, Lee JY, Choi YY, Lee JG. Laparoscopic appendectomy versus open appendectomy for suspected appendicitis during pregnancy: a systematic review and updated meta-analysis. BMC surg. 2019;19(1):41.
- McGory ML, Zingmond DS, Tillou A, Hiatt JR, Ko CY, Cryer HM. Negative appendectomy in pregnant women is associated with a substantial risk of fetal loss. J Am Coll Surg. 2007;205(4):534-40.
- Vujic J, Marsoner K, Lipp-Pump A, Klaritsch P, Mischinger H, Kornprat P. Non-obstetric surgery during pregnancy–an eleven-year retrospective analysis. BMC Pregnancy Childbirth. 2019;19(1):382.
- Dindo D, Demartines N, Clavien P-A. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240(2):205.
- Akbas A, Aydin Kasap Z, Hacim NA, Tokocin M, Altinel Y, Yigitbas H, et al. The value of inflammatory markers in diagnosing acute appendicitis in pregnant patients. Ulus Travma Acil Cerrahi Derg. 2020;26(5):769-76.
- Çınar H, Aygün A, Derebey M, Tarım İA, Akalın Ç, Büyükakıncak S, et al. Significance of hemogram on diagnosis of acute appendicitis during pregnancy. Ulus Travma Acil Cerrahi Derg. 2018;24(5):423-8.
- Mei Z, Li H, Serdula MK, Flores‐Ayala RC, Wang L, Liu JM, et al. C‐reactive protein increases with gestational age during pregnancy among Chinese women. Am J Hum Biol. 2016;28(4):574-9.
- Patel D, Fingard J, Winters S, Low G. Clinical use of MRI for the evaluation of acute appendicitis during pregnancy. Abdom Radiol. 2017;42(7):1857-63.
- Duke E, Kalb B, Arif-Tiwari H, Daye ZJ, Gilbertson-Dahdal D, Keim SM, et al. A systematic review and meta-analysis of diagnostic performance of MRI for evaluation of acute appendicitis. AJR Am J Roentgenol. 2016;206(3):508-17.
- Yoon I, Slesinger TL. Radiation Exposure In Pregnancy. 2019.
- Practice CoO. Committee opinion No. 723: guidelines for diagnostic imaging during pregnancy and lactation. Obstet Gynecol. 2017;130(4):e210.
- Mantoglu B, Altintoprak F, Firat N, Gonullu E, Dikicier E, Akdeniz Y, et al. Reasons for Undesirable Pregnancy Outcomes among Women with Appendicitis: The Experience of a Tertiary Center. Emerg Med Int. 2020;2020.
- Şenocak R, Çelik Su, Kaymak Ş. Diagnosis, Management And Clinicopathological Features Of Acute Appendicitis In Pregnant Women And Its Impact On Fetal Outcomes. İstanbul Tıp Fakültesi Dergisi.135-40.
- Ibiebele I, Schnitzler M, Nippita T, Ford JB. Appendicectomy during pregnancy and the risk of preterm birth: a population data linkage study. Aust N Z J Obstet Gynaecol. 2019;59(1):45-53.
- Frountzas M, Nikolaou C, Stergios K, Kontzoglou K, Toutouzas K, Pergialiotis V. Is the laparoscopic approach a safe choice for the management of acute appendicitis in pregnant women? A meta-analysis of observational studies. Ann R Coll Surg Engl. 2019;101(4):235-48.
- Yumi H. Guidelines for diagnosis, treatment, and use of laparoscopy for surgical problems during pregnancy. Surg Endosc. 2008;22(4):849-61.
- Salminen P, Tuominen R, Paajanen H, Rautio T, Nordström P, Aarnio M, et al. Five-year follow-up of antibiotic therapy for uncomplicated acute appendicitis in the APPAC randomized clinical trial. JAMA. 2018;320(12):1259-65.
- Kuczkowski KM. Nonobstetric surgery during pregnancy: what are the risks of anesthesia? Obstet Gynecol Surv. 2004;59(1):52-6.
- Olutoye OA, Baker BW, Belfort MA. FDA Warning on Anesthesia and Brain Development: Am J Obstet Gynecol. 2018;218(1):98-102.
Details
| Primary Language | English |
|---|---|
| Subjects | Surgery |
| Journal Section | Research Articles |
| Authors | |
| Publication Date | March 1, 2022 |
| Submission Date | June 3, 2021 |
| Acceptance Date | July 24, 2021 |
| Published in Issue | Year 2022 Volume: 29 Issue: 1 |
Süleyman Demirel Üniversitesi Tıp Fakültesi Dergisi/Medical Journal of Süleyman Demirel University is licensed under Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International.