Abstract
Objective
Acute appendicitis is the most common cause of nonobstetric
acute abdomen in pregnant women. The
fact that sympathomatology brings to mind primarily
obstetric causes in pregnant patients, physiological
leukocytosis is observed throughout pregnancy, and
limitations in imaging methods cause confusion in the
diagnosis. This makes the need for detailed evaluation
in laboratory parameters inevitable. The aim of
the study is to reveal the relationship of laboratory
parameters such as neutrophil lymphocyte ratio
(NLR), platelet lymphocyte ratio (PLR), lymphopenia
with the diagnosis of appendicitis and its diagnostic
power.
Material and Method
In the evaluation of 31 patients who were operated
on with the diagnosis of acute appendicitis during
pregnancy between January 2017 and February
2021 were evaluated. Correlation and roc analysis
were performed by evaluating patients' demographic
data, laboratory results, ultrasonography or magnetic
resonance imaging reports and intraoperative
findings.
Results
A significant correlation was found between
detection of appendicitis in exploration and increased
neutrophils, leukocytosis, and NLR (p: 0.014, p:
0.015, p: 0.020, respectively). Again, the presence
of lymphopenia, high NLR and increased palletelet /
lymphocyte ratio (PLR) were found to be associated
with prolonged hospitalization (p:0.037, p:0.008, and
p:0.024, respectively). Roc analysis also showed that
leukocytosis [AUC: 0.938 (95%CI: 0-1.00, p:0.019)],
neutrophil elevation [AUC: 0.938 (95%CI: 0-1.00,
p:0.019)] and NLR [AUC: 0.917 (0-1.00 p: 0.025)]
was found to have the power to reveal the presence
of significant acute appendicitis.
Conclusion
It is recommended to use hemogram parameters and
imaging methods effectively in the diagnosis of acute
appendicitis in pregnants.
Keywords
Supporting Institution
yok
Project Number
yok
Thanks
I would like to thank the editorial team and the referees in advance for their valuable comments and contributions.
References
- 1. Nakashima M, Takeuchi M, Kawakami M. Clinical outcomes of acute appendicitis during pregnancy: conservative management and appendectomy. World Journal of Surgery, 2021;45(6): 1717-1724.
- 2. Jung SJ, Lee DK, Kim JH, Kong PS, Kim KH, Bae SW. Appendicitis during pregnancy: the clinical experience of a secondary hospital. Journal of the Korean Society of Coloproctology, 2012;28(3):152-159.
- 3. Di Saverio S, Podda M, De Simone B, et al. Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World journal of emergency surgery, 2020; 15(1):1-42.
- 4. İlhan M, İlhan G, Gök AF, Bademler S, Verit Atmaca F, Ertekin C. Evaluation of neutrophil–lymphocyte ratio, platelet–lymphocyte ratio and red blood cell distribution width–platelet ratio as early predictor of acute pancreatitis in pregnancy. The Journal of Maternal-Fetal & Neonatal Medicine, 2016; 29(9):1476-1480.
- 5. Weinstein MS, Feuerwerker S, Baxter JK. Appendicitis and cholecystitis in pregnancy. Clinical Obstetrics and Gynecology, 2020;63(2):405-415.
- 6. Ishaq A, Khan MJH, Pishori T, Soomro R, Khan S. Location of appendix in pregnancy: does it change? Clinical and Experimental Gastroenterology, 2018;11:281-287.
- 7. Hiersch L, Yogev Y, Ashwal E, From A, Ben-Haroush A, Peled Y. The impact of pregnancy on the accuracy and delay in diagnosis of acute appendicitis. The Journal of Maternal-Fetal & Neonatal Medicine, 2014;27(13):1357-1360.
- 8. Fugazzola P, Ceresoli M, Agnoletti V, et al. The SIFIPAC/ WSES/SICG/SIMEU guidelines for diagnosis and treatment of acute appendicitis in the elderly (2019 edition). World Journal of Emergency Surgery, 2020;15(1):1-15.
- 9. Mohammed IF, AlBayati BA. Acute appendicitis in pregnancy: the presentation and the outcome. Eur J Molecul Clin Med, 2020;7(6):450-455.
- 10. 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 surgery, 2019;19(1):1-12.
- 11. Rottenstreich M, Tankel J, Vilk Ayalon N, Rotem R, Yellinek S, Khatib F, Grisaru-Granovsky S. Laparoscopic negative appendectomy during pregnancy is associated with adverse neonatal outcome. Surgical Endoscopy, 2022;36(1):544-549.
- 12. Akbas A, Aydın Kasap Z, Hacım NA, Tokocin M, Altınel Y, Yiğitbaş H, Meriç S, Okumuş B. The value of inflammatory markers in diagnosing acute appendicitis in pregnant patients. Ulus Travma Acil Cerrahi Derg, 2020;26(5):769-776.
- 13. Başkıran A, İnce V, Çiçek E, Şahin T, Dirican A, Balıkçı Çiçek İ, Işık B, Yılmaz S. Efficacy of laboratory tests and ultrasonography in the diagnosis of acute appendicitis in gravid patients according to the stages of pregnancy. Ulus Travma Acil Cerrahi Derg, 2018;24(4):333-336
- 14. Gentles JQ, Meglei G, Chen L, Hague CJ, Melck AL. Is neutrophilia the key to diagnosing appendicitis in pregnancy? The American Journal of Surgery, 2020;219(5):855-859.
- 15. Hajibandeh S, Hajibandeh S, Hobbs N, Mansour M. Neutrophil- to-lymphocyte ratio predicts acute appendicitis and distinguishes between complicated and uncomplicated appendicitis: a systematic review and meta-analysis. The American Journal of Surgery, 2020;219(1):154-163.
- 16. Mervak BM, Wilson SB, Handly BD, Altun E, Burke. LM MRI of acute appendicitis. Journal of Magnetic Resonance Imaging, 2019;50(5):1367-1376.
- 17. Poletti PA, Botsikas D, Becker M, Picarra M, Rutschmann OT, Buchs NC, Zaidi H, Platon A. Suspicion of appendicitis in pregnant women: emergency evaluation by sonography and low-dose CT with oral contrast. European Radiology, 2019;29(1):345-35
Abstract
Amaç
Akut apandisit, gebelerde obstetrik olmayan akut batının
en sık nedenidir. Gebe hastalarda sempatomatolojinin
akla ilk olarak obstetrik nedenleri getirmesi,
fizyolojik lökositozun gebelik boyunca görülmesi ve
görüntüleme yöntemlerindeki kısıtlılıklar tanıda kafa
karışıklığına neden olmaktadır. Bu durum laboratuvar
parametrelerinde ayrıntılı değerlendirme ihtiyacını kaçınılmaz
kılmaktadır. Çalışmanın amacı nötrofil lenfosit
oranı (NLR), trombosit lenfosit oranı (PLR), lenfopeni
gibi laboratuvar parametrelerinin apandisit tanısı
ile ilişkisini ve tanısal gücünü ortaya koymaktır.
Gereç ve Yöntem
Değerlendirmede Ocak 2017-Şubat 2021 tarihleri arasında
gebelikte akut apandisit tanısı ile opere edilen
31 hasta değerlendirildi. Hastaların demografik verileri,
laboratuvar sonuçları, ultrasonografi veya manyetik
rezonans görüntüleme raporları ve intraoperatif
bulguları değerlendirilerek korelasyon ve roc analizi
yapıldı.
Bulgular
Eksplorasyonda apandisit saptanması ile nötrofil, lökositoz
ve NLR artışı arasında anlamlı bir ilişki bulundu
(sırasıyla p: 0,014, p: 0,015, p: 0,020). Yine
lenfopeni varlığı, yüksek NLR ve artmış palet/lenfosit
oranı (PLR) uzamış yatış ile ilişkili bulundu (sırasıyla,
p:0,037, p:0,008, p:0,024). Roc analizi ayrıca lökositoz
[AUC: 0,938 (%95 CI: 0-1,00, p:0,019)], nötrofil
yüksekliği [AUC: 0,938 (%95 CI: 0-1,00, p:0,019)]
ve NLR [AUC: 0,917 (0-1,00 p: 0,025)] anlamlı akut
apandisit varlığını ortaya koyma gücüne sahip olduğu
bulundu.
Sonuç
Gebelerde akut apandisit tanısında hemogram parametrelerinin
ve görüntüleme yöntemlerinin etkin bir
şekilde kullanılması önerilmektedir.
Keywords
Project Number
yok
References
- 1. Nakashima M, Takeuchi M, Kawakami M. Clinical outcomes of acute appendicitis during pregnancy: conservative management and appendectomy. World Journal of Surgery, 2021;45(6): 1717-1724.
- 2. Jung SJ, Lee DK, Kim JH, Kong PS, Kim KH, Bae SW. Appendicitis during pregnancy: the clinical experience of a secondary hospital. Journal of the Korean Society of Coloproctology, 2012;28(3):152-159.
- 3. Di Saverio S, Podda M, De Simone B, et al. Diagnosis and treatment of acute appendicitis: 2020 update of the WSES Jerusalem guidelines. World journal of emergency surgery, 2020; 15(1):1-42.
- 4. İlhan M, İlhan G, Gök AF, Bademler S, Verit Atmaca F, Ertekin C. Evaluation of neutrophil–lymphocyte ratio, platelet–lymphocyte ratio and red blood cell distribution width–platelet ratio as early predictor of acute pancreatitis in pregnancy. The Journal of Maternal-Fetal & Neonatal Medicine, 2016; 29(9):1476-1480.
- 5. Weinstein MS, Feuerwerker S, Baxter JK. Appendicitis and cholecystitis in pregnancy. Clinical Obstetrics and Gynecology, 2020;63(2):405-415.
- 6. Ishaq A, Khan MJH, Pishori T, Soomro R, Khan S. Location of appendix in pregnancy: does it change? Clinical and Experimental Gastroenterology, 2018;11:281-287.
- 7. Hiersch L, Yogev Y, Ashwal E, From A, Ben-Haroush A, Peled Y. The impact of pregnancy on the accuracy and delay in diagnosis of acute appendicitis. The Journal of Maternal-Fetal & Neonatal Medicine, 2014;27(13):1357-1360.
- 8. Fugazzola P, Ceresoli M, Agnoletti V, et al. The SIFIPAC/ WSES/SICG/SIMEU guidelines for diagnosis and treatment of acute appendicitis in the elderly (2019 edition). World Journal of Emergency Surgery, 2020;15(1):1-15.
- 9. Mohammed IF, AlBayati BA. Acute appendicitis in pregnancy: the presentation and the outcome. Eur J Molecul Clin Med, 2020;7(6):450-455.
- 10. 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 surgery, 2019;19(1):1-12.
- 11. Rottenstreich M, Tankel J, Vilk Ayalon N, Rotem R, Yellinek S, Khatib F, Grisaru-Granovsky S. Laparoscopic negative appendectomy during pregnancy is associated with adverse neonatal outcome. Surgical Endoscopy, 2022;36(1):544-549.
- 12. Akbas A, Aydın Kasap Z, Hacım NA, Tokocin M, Altınel Y, Yiğitbaş H, Meriç S, Okumuş B. The value of inflammatory markers in diagnosing acute appendicitis in pregnant patients. Ulus Travma Acil Cerrahi Derg, 2020;26(5):769-776.
- 13. Başkıran A, İnce V, Çiçek E, Şahin T, Dirican A, Balıkçı Çiçek İ, Işık B, Yılmaz S. Efficacy of laboratory tests and ultrasonography in the diagnosis of acute appendicitis in gravid patients according to the stages of pregnancy. Ulus Travma Acil Cerrahi Derg, 2018;24(4):333-336
- 14. Gentles JQ, Meglei G, Chen L, Hague CJ, Melck AL. Is neutrophilia the key to diagnosing appendicitis in pregnancy? The American Journal of Surgery, 2020;219(5):855-859.
- 15. Hajibandeh S, Hajibandeh S, Hobbs N, Mansour M. Neutrophil- to-lymphocyte ratio predicts acute appendicitis and distinguishes between complicated and uncomplicated appendicitis: a systematic review and meta-analysis. The American Journal of Surgery, 2020;219(1):154-163.
- 16. Mervak BM, Wilson SB, Handly BD, Altun E, Burke. LM MRI of acute appendicitis. Journal of Magnetic Resonance Imaging, 2019;50(5):1367-1376.
- 17. Poletti PA, Botsikas D, Becker M, Picarra M, Rutschmann OT, Buchs NC, Zaidi H, Platon A. Suspicion of appendicitis in pregnant women: emergency evaluation by sonography and low-dose CT with oral contrast. European Radiology, 2019;29(1):345-35
Details
| Primary Language | English |
|---|---|
| Subjects | Surgery |
| Journal Section | Araştırma Makaleleri |
| Authors | |
| Project Number | yok |
| Publication Date | June 22, 2023 |
| Submission Date | January 23, 2023 |
| Acceptance Date | May 15, 2023 |
| Published in Issue | Year 2023 Volume: 30 Issue: 2 |
Süleyman Demirel Üniversitesi Tıp Fakültesi Dergisi/Medical Journal of Süleyman Demirel University is licensed under Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International.