Q: 32 year old female with 12 weeks of pregnancy presented with right lower quadrant pain with rebound tenderness. There is a huge clinical suspicion of Acute appendicitis. What should be the management approach beside starting full coverage antibiotics?



Answer:  According to the 2010 Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) guideline, laparoscopic appendectomy is suitable in suspected appendicitis in pregnant women. Overall, The SAGES guideline states that the laparoscopic approach should be preferred in women of childbearing age with presumed appendicitis.

Diagnostic laparoscopy can be performed only to confirm the diagnosis of appendicitis. If findings are positive, definitive surgical treatment should be performed. Perforation may increase the fetal and maternal morbidity. Therefore, aggressive management of the appendix is warranted in pregnant patients.

Advantages of laparoscopic appendectomy include increased cosmetic satisfaction, a decrease in the postoperative wound-infection rate, shortens hospital stay and convalescent period compared with open appendectomy. Disadvantages of laparoscopic appendectomy are increased cost and an operating time approximately 20 minutes longer than that of an open appendectomy.