Apendicitis y embarazo. Experiencia en el Hospital

Objective: To present the frequency of acute appendicitis during pregnancy and its diagnosis and handling. Setting: Private third level health care hospital with obstetric priority care. Design: Retrospective, descriptive, transversal study. Statistical analysis: Percentages as summary measure for qualitative variables. Patients and method: Pregnant patients that were subjected to appendectomy with a diagnosis of acute appendicitis in a 3-year period ( 2003-2005). Analyzed variables were: age, parity, gestational age, clinical data, time of evolution, surgical route, complications, total number of live newborns and of appendectomies in the same period. Results: Thirteen pregnant patients were subjected to appendectomy; incidence was of 1:928, which corresponds to 0.10% (9828 live newborns) and a relation of appendectomies in pregnant women versus non-pregnant women of 1:48 (630 appendectomies). Average age of our patients was of 30.69 years; 61.5% were in the second trimester of pregnancy. Ten cases were subjected to open surgery and three to laparoscopy. One case of preterm labor threat occurred. No maternal or perinatal deaths occurred. Conclusion: Frequency of appendicitis in pregnant women is higher at our hospital than reported in the literature. It occurs most frequently during the 2 nd trimester of pregnancy. Diagnosis was based on clinical data and 75% of the cases had an evolution of 24 h or less with a diagnostic certainty of 76.9%. Early multidisciplinary management (gynecologistobstetrician, surgeon and anesthesiologist) resulted in the absence of mortality and complications. Resumen Objetivo: Presentar la frecuencia de presentacion, diagnostico y manejo de apendicitis aguda durante el embarazo. Sede: Hospital privado de tercer nivel con prioridad obstetrica. Diseno: Retrospectivo, descriptivo, transversal. Analisis estadistico: Porcentajes como medida de resumen para variables cualitativas. Material y metodo: Pacientes embarazadas, que fueron operadas de apendicectomia con diagnostico de apendicitis aguda en un periodo de 3 anos (20032005). Las variables analizadas fueron: edad materna, paridad, edad gestacional, datos clinicos, tiempo de evolucion, via de abordaje quirurgico, complicaciones, total de nacidos vivos y de apendicectomias en mismo periodo. Resultados: 13 pacientes embarazadas fueron operadas de apendicectomia, la incidencia fue de 1:928 que corresponde al 0.10% (9,828 nacidos vivos) y una relacion de apendicectomias en embarazadas contra no embarazadas de 1:48 (630 apendicectomias). La edad promedio de nuestras pacientes fue de 30.69 anos. El 61.5% cursaba en el segundo trimestre del embarazo. Diez casos se operaron con tecnica abierta y 3 por laparoscopia. Se presento un caso de amenaza de parto pretermino, no hubo casos de muerte materna o perinatal. Conclusion: La frecuencia de apendicitis en embarazadas es mayor en nuestro hospital que en lo reportado en la literatura, se presenta mas frecuentemente en el 2do trimestre de embarazo. El diagnostico se sustento, basicamente, en los datos clinicos y el 75% de los casos tuvo un tiempo de evolucion de 24 h o menos con una certeza diagnostica de 76.9%.