|Discussion in 'All Categories' started by Dr G Phanipriya - Jan 11th, 2012 1:29 am.|
Dr G Phanipriya
|I had a 25yr old lady 9weeks pregnant with h/o sudden onset severe right lower quadrant pain associated with vomiting. O/E - She was afebrile. P-90/min, PA-Severe tenderness & rebound tenderness in RIF. Clinical diagnosis was Acute Appendicitis. TLC-13800, n-87%, CRP-24, USG-Unremarkable. She was managed conservatively for 24 hrs with IV antibiotics & analgesics with no relief of pain. She was taken up for Laparoscopic Appendicectomy. Intra-operatively, there was a twisted right adnexal mass over a fibrous band in the pelvis causing bluish-black discoloration (pre-gangrenous). The appendix looked grossly normal. After the adnexal mass was unwound, the colour returned to a healthy pink. So,it was decided to preserve the tube. Since the tube was preserved, I went ahead with Appendicectomy. I had two reasons for removing the appendix - 1)A grossly normal looking appendix may not be normal 2)Since the tube was being preserved, diagnostic disparity if pain recurred would have been removed. Histopathology report showed Appendix with atrophy & serositis
Am I right in removing the appendix in this particular case
re: Acute Abdomen in pregnancy by Dr M.K. Gupta - Jan 11th, 2012 10:28 pm
Dr M.K. Gupta
|Dear Dr G Phanipriya
If any obvious cause of pain is present innocent looking appendix may not be removed but Incidental appendectomy is considered to eventually be necessary in women with ovarian or tubal diseases and chronic pelvic pain, as the many of the appendices are found to have histopathologically confirmed pathology although being macroscopically normal (Wie et al., 2008).
Incidental appendectomy is reported to be safe and effective in women undergoing gynaecologic surgery, in women with chronic pelvic pain and in our opinion your decision was correct.
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