AKUTNI APEDNICITIS U POSTPARTALNOM PERIODU: DIJAGNOSTIČKI IZAZOV
Sažetak
Apendicitis u trudnoći i puerperijumu najčešći je uzrok neginekološkog oboljenja koje zahteva hitnu hirušku intervenciju. Za razliku od apendicitisa u trudnoći, mali broj radova bavi se apendicitisom koji nastaje u toku porođaja i u ranom puerperijumu. Najčešće infekcije u puerperijumu su puerperalni endometritis, infekcije urinarnog trakta, adneksalna torzija, tubo-ovarijumski apscesi, tromboza ovarijumskih vena, sepsa, pelvični tromboflebitis, pijelonefritis, pneumonija i holecistitis. Do poteškoća prilikom dijagnostikovanja akutnog apendicitisa u trudnoći i puerperijumu dolazi zbog oslabljenih simptoma i znakova usled distenzije trbušnog zida, dislokacije intraabdominalnih organa i smanjenog odgovora tikva na upalu. Glavni simptomi apendicitisa u trudnoći uključuju povraćanje, anoreksiju, mučninu, povišenu telesnu temperaturu, tahikardiju i bol u donjem desnom kvadrantu ili boku. Budući da apendicitis može biti uzrok neprepoznate refraktorne sepse u postpartalnom periodu, kod pacijentkinja posle porođaja, osim na sepsu, treba obratiti pažnju na upalu slepog creva. Stoga, neophodan je timski rad ginekologa i hirurga.
Reference
Akın T, Birben B, Akkurt G, Karaca O, Donmez N, Er S, et al. Acute Appendicitis During Pregnancy: A Case Series of 42 Pregnant Women. Cureus 2021;13(8):e17627. [CrossRef][PubMed]
Andersen B, Nielsen T. Appendicitis in Pregnancy: Diagnosis, Management and Complications. Acta Obstet Gynecol Scand 1999;78(9):758-62. [CrossRef][PubMed]
Aptilon Duque G, Oladipo AF, Lotfollahzadeh S. Appendicitis in Pregnancy. Treasure Island (FL): StatPearls Publishing; 2024. [PubMed]
Arbib N, Aviram A, Ben-Ziv RG, Sneh O, Yogev Y, Hadar E. The Effect of Labor and Delivery on White Blood Cell Count. J Matern Fetal Neonatal Med 2016;29(18):2904-8. [CrossRef][PubMed]
Brown JS, Wilson C, Coleman S, Joypaul BV. Appendicitis in Pregnancy: an ongoing diagnostic dilemma. Colorectal Disease 2009;11(2):116-22. [CrossRef][PubMed]
Franca Neto AH, Amorim MM, Nóbrega BM. Acute Appendicitis in Pregnancy: literature review. Rev Assoc Med Bras 2015;61(2):170-7. [CrossRef][PubMed]
Guttman R, Goldman RD, Koren G. Appendicitis During Pregnancy. Can Fam Physician 2004;50:355-7. [PubMed]
Körner H, Söndenaa K, Söreide J, Andersen E, Nysted A, Lende TH, et al. Incidence of Acute Nonperforated and Perforated Appendicitis: Age-specific and Sex-specific Analysis. World J. Surg 1997;21:313–7. [CrossRef][PubMed]
Mertens K, Muys J, Jacquemyn Y. Postpartum C-Reactive Protein: A Limited Value to Detect infection or inflammation. Facts Views Vis Obgyn 2019;11(3):243-50. [PubMed]
Mostbeck G, Adam EJ, Nielsen MB, Claudon M, Clevert D, Nicolau C, et al. How to Diagnose Acute Appendicitis: Ultrasound First. Insights Imaging 2016:7;255–63. [CrossRef][PubMed]
Nunnelee JD, Musselman R, Spaner SD. Appendectomy in Pregnancy and Postpartum: analysis of data from a large private hospital. Clin Excell Nurse Pract 1999;3(5):298-301. [PubMed]
Paccolat C, Harbarth S, Courvoisier D, Irion O, de Tejada BM. Procalcitonin Levels During Pregnancy, Delivery and Postpartum. J Perinat Med 2011;39(6):679-83. [CrossRef][PubMed]
Pastore P, Loomis DM, Sauret J. Appendicitis in Pregnancy. The Journal of the American Board of Family Medicine November 2006;19(6):621-6. [CrossRef][PubMed]
Robinson DP, Klein SL Pregnancy and Pregnancy-associated Hormones Alter Immune Responses and Disease Pathogenesis. Hormones and Behavior 2012:62(3);263-71. [CrossRef][PubMed]
Stone K. Acute Abdominal Emergencies Associated with Pregnancy. Clinical Obstetrics and Gynecology 2002;45(2):553-61. [CrossRef][PubMed]
Tamir IL, Bongard FS, Klein SR. Acute Appendicitis in the Pregnant Patient. Am J Surg 1990;160:571–6. [CrossRef][PubMed]
Wadhawan D, Singhal S, Sarda N, Arora R. Appendicitis in Postpartum Period: A Diagnostic Challenge. J Clin Diagn Res 2015;9(10):QD10-1. [CrossRef][PubMed]
Yale S, Tekiner H, Yale ES. Physical Examination and Appendiceal Signs During Pregnancy. Cureus 2022;14(2):e22164. [CrossRef][PubMed]
Zhang Y, Zhao Y, Qiao J. Diagnosis of Appendicitis During Pregnancy and Perinatal Outcome in the Late Pregnancy. Chinese Medical Journal 2009:122(5);521-4. [PubMed]
Zingone F, Sultan AA, Humes DJ, West J. Risk of Acute Appendicitis in and Around Pregnancy: Population-based Cohort Study From England. Ann Surg 2015:261(2);332-7. [CrossRef][PubMed]
