A 23-year-old woman who is 28 weeks pregnant presents with right-sided abdominal pain, leukocytosis, and an abdominal ultrasound that does not visualize the appendix. What intervention would you recommend?
Appendicitis complicates 1/766 bihs and is rare in the third trimester. The rate of negative appendectomy in the pregnant patient appears to be about 25% higher than in nonpregnant patients. This is not, however, a benign procedure as a negative appendectomy is associated with a 4% risk of fetal loss and a 10% risk of early delivery. The American College of Radiology recommends the use of nonionizing radiation techniques as front-line imaging in pregnant women. Serial examinations would be inappropriate as rates of fetal loss are considerably higher in patients with complicated appendicitis and the greatest oppounity to improve fetal outcomes is to improve diagnostic accuracy. Ultrasound Scan, being the easiest imaging option to carry out during pregnancy, is done to confirm that the condition is appendicitis. If results of the Ultrasound Scan are not conclusive, an MRI Scan is carried out. It also carries no risk of radiation, even to pregnant women. Abdominal CT scan carries risk or radiation so MRI is prefered.
Exploratory laparoscopy.
Abdominal CT scan.
Abdominal magnetic resonance imaging (MRI) scan.
Serial clinical observations.
Vermiform Appendix