Transactions of the Nineteenth Annual Meeting of the American Gynecological and Obstetrical SocietyThe use of helical computed tomography in pregnancy for the diagnosis of acute appendicitis☆
Section snippets
Material and methods
All pregnant patients at our institution who underwent helical CT for the presumed clinical diagnosis of acute appendicitis were retrospectively reviewed. The study period was April 1997 to February 1998. Maternal demographic information, pregnancy history, hospital course, and pathologic findings, if applicable, were collected. The final outcome for the index pregnancy was also obtained.
Helical CT was performed by standard departmental protocol and has been described elsewhere.5 Helical CT
Results
Seven patients were identified during the study period. All of these patients were in the second and third trimester of pregnancy (Table 1).Case No. Age (y) G/P GA (wk) Pain Fever N/V Anorexia WBC Time (h) symptoms to presentation 1 28 6/3 24 Right side of abdomen radiating to back – +/– + 21.2 6 2 39 3/2 23 Central uterine radiating to bilateral lower quadrants – –/– – 19 12 3 30 2/1 32 Right lower quadrant – –/– + 10.2 6 4 27 1/0 30 Periumbilical radiating to right lower quadrant – +/+ + 9.3 1 5 20 1/0 29 Right side
Comment
In this series of pregnant patients suspected of having acute appendicits, helical CT imaging accurately diagnosed 2 cases of acute appendicits. In the 5 other cases negative helical CT results were confirmed on the basis of clinical follow-up, and operative intervention was avoided.
Helical CT has been shown to be highly sensitive and specific for the diagnosis of acute appendicitis in the nonobstetric population. In a series of 100 patients aged 6 to 75 years with suspected acute appendicitis
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Cited by (85)
Evaluation of Abdominal Emergencies
2023, Surgical Clinics of North AmericaChallenges in Magnetic Resonance Imaging for Suspected Acute Appendicitis in Pregnant Patients
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2015, Surgical Clinics of North AmericaImaging of Acute Abdomen in Pregnancy
2013, Radiologic Clinics of North AmericaSurgery in Pregnancy
2012, Current Problems in SurgeryImaging of Abdominal Pain in Pregnancy
2012, Radiologic Clinics of North AmericaCitation Excerpt :If MR imaging cannot be performed, due to the occasional contraindication or if not available emergently, CT can be used as a second-line or third-line examination. Most of the small series reported on the utility of CT for appendicitis in pregnancy were with oral and IV contrast, although rectal contrast has been used exclusively or in combination with other contrast material.51,52 Positive CT findings are the same as in nonpregnant patients, although as with MR imaging, particularly in the later stages of gestation, prominent but normal adnexal vessels, or collapsed bowel loops, may be confused with an abnormal appendix.
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Reprint requests: Mary Ames Castro, MD, University of Wisconsin Medical School/MCC, Sinai Samaritan Medical Center, Department of OB/GYN, 5A, P.O. Box 342, Milwaukee, WI 53201.