Pregnancy and Appendicitis

Appendicitis is a frequent part of the differential diagnosis of right lower quadrant pain in pregnancy. The differential also includes cholecystitis, pancreatitis, gastroenteritis, right lower lobe pneumonia, ovarian torsion, uterine myoma degeneration, pyelonephritis, urinary tract infection, and round ligament pain. For evaluation of gynecologic etiologies and fetal well-being, depending on gestational age, an OBGYN consult is appropriate. Evaluation should include physical exam, vital sign review, and laboratory value review. Mild tachycardia and leukocytosis can be normal physiologic changes in pregnancy. Imaging should start with ultrasound and if inconclusive proceed to magnetic resonance imaging (MRI). Management if appendicitis if suspected is surgical. Surgical approach should be influenced by size of the gravid uterus, comfort with laparoscopic versus open surgery, and concern for appendiceal rupture. Patients should also be counseled about risk of preterm labor and fetal loss. Risk of fetal loss is highest in the setting of appendiceal rupture.