Details

Autor(en) / Beteiligte

• Gentles, J. Quinn
• Meglei, Gabriela
• Chen, Leo
• Hague, Cameron J.
• Melck, Adrienne L.

Titel

Is neutrophilia the key to diagnosing appendicitis in pregnancy?

Ist Teil von

• The American journal of surgery, 2020-05, Vol.219 (5), p.855-859

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2020

Link zum Volltext

Quelle

Alma/SFX Local Collection

Beschreibungen/Notizen

• The diagnosis of acute appendicitis (AA) in pregnancy remains challenging. We investigated which preoperative clinical factors are most predictive of AA in pregnant women. 164 pregnant patients undergoing magnetic resonance imaging for suspected AA were retrospectively reviewed. Logistic regression was used to compare those with pathologically confirmed AA and those without. 28 patients (17.1%) had pathologically confirmed AA. 42.9% (n = 12) were perforated at the time of operation. Factors associated with AA included history of emesis (p = 0.005), migratory abdominal pain (p = 0.006), rebound tenderness (p = 0.01), elevated white blood cell count (p = 0.003), elevated Alvarado Score (p < 0.001), elevated neutrophil count (p = 0.021), and left shift (p = 0.001). As a screening test, a left shift with neutrophils >70% provided a sensitivity and negative predictive value of 100.0%. Every patient in our series with AA had a left shift. Neutrophil count and percentage should be considered in the diagnostic evaluation of these patients to better guide resource utilization and treatment. •Neutrophil percentage <70% gave a 100% negative predictive value for appendicitis.•High rates of perforated appendicitis continue to be observed in pregnancy.•Neutrophilia should be considered in the diagnosis of appendicitis in pregnancy.