Management of acute appendicitis in pregnant patients at Metropolitano Hospital, 2009-2024

Abstract

Acute appendicitis is the most common non-obstetric surgical cause during pregnancy. The diagnosis is a true challenge due to physiological and anatomical changes; ultrasound is the first-line study, and when it is inconclusive, simple magnetic resonance imaging (MRI) can help reduce unnecessary appendectomies. Laparoscopic surgical resolution is considered the method of choice. Methodology: A retrospective cross-sectional study was conducted analyzing information from patients admitted to the Obstetrics and Gynecology and General Surgery departments of the Metropolitan Hospital of Quito with diagnoses of acute appendicitis from 2009 to 2024. A total of 37 patients were studied, and necessary data were collected from the digital medical history system GEMA and MV into a database for further conclusions. Results: The initial diagnosis of this condition was based on clinical signs and laboratory parameters. Imaging tests such as ultrasound and MRI were not essential for establishing the final diagnosis. 91.9% of cases were surgically resolved via laparoscopy, regardless of the gestational age. No immediate post-surgical complications were reported, and the average gestational age at the end of pregnancy was 37.2 weeks. 14.8% ended in preterm delivery, but these specific cases had other unrelated obstetric complications and medical history. Conclusions: Acute appendicitis is the most frequent non-obstetric surgical cause during pregnancy, and early diagnosis is crucial to ensure a favorable prognosis for both the mother and fetus. Clinical evolution and laboratory parameters continue to be the most reliable resources for diagnosis, with imaging studies serving as auxiliary tools, often inconclusive. The currently recommended approach is laparoscopic appendectomy regardless of the trimester of pregnancy, as this technique offers several advantages, including early recovery. As for the obstetric complications reported at the end of pregnancy, they were not directly related to the history of appendicitis but were linked to other specific obstetric risk factors for each pregnant patient.