SUMNJA NA APENDICITIS U TRUDNOĆI: POJAVNOST I POSTUPAK

Abstract

Objective. An evaluation of the the clinical picture, diagnostic procedures and outcome of appendicitis in pregnant women. Method. Retrospective analytic study of 28 appendectomies performed during pregnancy for suspected appendicitis in our hospital at period April 2004 to September 2006. All files and medical records of these patients were analyzed and studied. The including variables (demographic, clinical, laboratory and surgical outcomes data) were collected retrospectively. The number of correct and wrong diagnosis were reported and comparison of perinatal outcome, maternal morbidity and different variables in negative and positive laparotomy performed. Results. The prevalence of suspected appendicitis in pregnancy is 0.29%. Incidence of negative laparotomies was 36%. The most correct diagnostic findings for acute appendicitis were history of periumbilical pain, anorexia and iliac fossa findings. Delayed surgical intervention significantly increased maternal morbidity (p=0.003), rate of premature labor (p=0.031) and rate of abortion but not significantly (p=0.28). Conclusion. The prevalence of suspected appendicitis during pregnancy in our environment during this period was higher than the reported incidence; the rate of wrong diagnosis is still high. Good clinical assessment with adjunct ultrasonic examination could reduce the incidence of negative laparotomies and prevent late complications. Delay in operation is leading to higher rate of maternal morbidity and adversely affect the obstetric outcome.Cilj rada. Vrednovanje kliničke slike, dijagnostičkih postupaka i ishoda apendicitisa u trudnica. Metode. Retrospektivno je analizirano 28 trudnica s apendektomijom tijekom trudnoće zbog sumnje na appendicitis. U bolnici u Zarqua-i u Jordanu u razoblju od travnja 2004. do rujna 2006. učinjeno je 28 apendektomija tijekom trudnoće. Analizirane su povijesti bolesti tih 28 trudnica. Istraživane su razne varijable: demografske karakteristike pacijentica, kliničke, laboratirijske i kirurški ishod. Ustanovljen je broj točnih i pogrešnih dijagnoza te uspoređen perinatalni ishod i maternalni morbiditet u pacijentica s pozitivnim i negativnim laparotomijskim nalazom. Rezultati. Pojavnost sumnje na apendicitis u trudnoći je bila 0,29% svih registriranih trudnoća. U 36% sumnji je laparotomijom nađen normalni apendiks. Najtočniji dijagnostički nalaz za akutni apendicitis je bio periumbilikalni bol, anoreksija i osjetljivost ilijačnih šupljina. Odgađanje kirurške intervencije je znakovito povisilo majčin morbiditet (p=0,003), stopu preranog poroda (p=0,031) te neznakovito stopu pobačaja (p=0,28). Zaključak. Pojavnost sumnje na apendicitis u trudnoći je u našim prostorima bila viša nego se uobičajeno spominje; stopa krivih dijagnoza je još visoka. Dobra klinička psosudba uz dodatak ultrazvučnog pregleda mogla bi smanjiti učestalost negativnih laparotomija i spriječiti kasnije komplikacije. Odgoda operacije povećava maternalni morbiditet i obrnuto pridonosi opstetričkom ishodu