ACUTE APPENDICITIS IN PREGNANCY : HOW TO MANAGE? HAMRI.A, AARAB.M,NARJIS.Y, RABBANI.K, LOUZI.A,BENELKHAIAT.R, FINECH.B SERVICE DE CHIRURGIE DIGESTIVE MARRAKECH CONGRÈS NATIONAL DE CHIRURGIE

Introduction  Acute appendicitis is the most common surgical emergency non-obstetric pathology during pregnancy, and its incidence is reported to be between 1/1250 and 1/1500 pregnancies, with 50% of cases in the second trimester. when acute appendicitis is associated with perforation and peritonitis, there is a considerable fetal loss  However, many other pathologies also occur during pregnancy that could cause abdominal pain, and require treatment  Diagnosis is difficult because many symptoms are considered ’normal’ during pregnancy. The high prevalence of nausea, vomiting and abdominal pain in the normal obstetric patient population leads to the delayed surgical intervention CONGRÈS NATIONAL DE CHIRURGIE Object Investigate the clinical presentation, management and outcome in patients who underwent appendectomy during pregnancy

Material and Method  In this report, twelve pregnant patients who were consulted to the abdominal emergency with in the last four years are evaluated retrospectively, between January 2012 and december 2015  Clinical data collected retrospectively included physical examination findings, age of the patients, week of pregnancy, presenting symptoms, ultrasonographic confirmation, leukocyte count, and postoperative complications  All patients were assessed by a gynecologist and a general surgeon before and after surgery. The diagnosis of acute appendicitis was based on clinical examination, ultrasound and leukocyte count, and pregnancy was confirmed by ultrasound  The pregnant patients were evaluated regarding age, gestational age, clinical and laboratory examinations, imaging studies, operative findings, mean hospital stay, mean operative time, and outcome  Appendectomies were performed by open approach. General anesthesia was employed routinely during the operation. Urinary catheters were used routinely CONGRÈS NATIONAL DE CHIRURGIE

Results  The mean age of the patients was 26 (19-35) years. The mean gestational age was 17.6 weeks (4-33 weeks)  Eight patients were in the third trimester, one were in the first trimester and three were in the second trimester of pregnancy  All 12 patients were admitted with complaints abdominal pain, vomiting  Ultrasonography was performed in all patients after gynecological examination  In ten of twelve patients, acute appendicitis was confirmed. One case was appendiceal abscess and the last one was acute generalized peritonitis  The appendectomy was performed for all our patients by open laparotomy  The median time between consultation and operation was 6 hours (3-10)  There was an abortion case and no maternal morbidity or mortality in any patient. All 11 patients delivered healthy babies during the postoperative course  The histology showed appendicitis without specificity or manligancy in all cases CONGRÈS NATIONAL DE CHIRURGIE

Conclusions  Appendicitis in pregnancy should be suspected when a pregnant woman complais of new abdominal pain ( unless proven otherwise)  Careful physical examination is key to making the diagnosis  Delay of operation correlates to more inflammatory changes in the appendix and to higher maternal and fetal complication rates  An early surgical intervention should be performed with any suspicion. The type of surgery depends on the surgeon’s preference and experience  Primary care providers must assume a responsable role in recognizing potential signs and symptoms of appendicitis in pregnancy and initiate prompt action to reduce negative outcomes CONGRÈS NATIONAL DE CHIRURGIE