Acute appendicitis in pregnancy: A case series and literature review

Abstract

Introduction: Acute appendicitis is the most common non-obstetric surgical emergency in pregnancy, with an incidence of 0.05-0.1%. Its diagnosis is challenging due to altered anatomy and overlapping symptoms. This study describes the clinical features, management, and maternal-fetal outcomes of acute appendicitis in pregnancy. Methods: A retrospective descriptive study was conducted at Menzel Temime Regional Hospital, Tunisia, from January 2018 to December 2019, including four pregnant women with histologically confirmed acute appendicitis. Data on clinical presentation, diagnostics, surgical management, and out- comes were collected from medical records. A literature review was performed to contextualize findings. Results: All cases presented with right iliac fossa pain and fever; gestational ages ranged from 16 to 35 weeks, with three in the second trimester. Hyperleukocytosis (15,500-24,500/mmS) and elevated C-reactive protein (19-344 mg/L) were consistent. Ultrasound confirmed diagnosis in three cases; one required computed tomography. All underwent laparotomy with appendectomy, with one perforation and one localized peritonitis. One case resulted in preterm delivery with neonatal death; no maternal deaths occurred. Conclusion: Acute ap- pendicitis in pregnancy poses significant maternal-fetal risks, necessitating prompt diagnosis and surgical intervention. Ultrasound is the primary diagnostic tool, with laparotomy preferred over laparoscopy in this setting. Early management reduces complications, but preterm delivery remains a concern.