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Report by Robert Williams, Specialist Registrar
Search checked by Jonathan Shaw, Specialist Registrar
Royal Oldham Hospital, Oldham, UK
A short cut review was carried out to establish whether ultrasonography has valuable clinical utility in pregnant women with suspected appendicitis. Ten papers were found using the reported searches, of which three presented the best evidence to answer the clinical question. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of these best papers are tabulated. It is concluded that while a positive scan might be a useful indicator, a negative scan is not.
A 28‐year‐old woman presents to the emergency department with a 4‐hour history of right iliac fossa pain, and an examination suggestive of acute appendicitis. You are aware that an isolated blood count is neither specific nor sensitive in the diagnosis of appendicitis, and the on‐call surgeon suggests that an ultrasound scan may be helpful.
In [women with possible appendicitis in pregnancy] is [abdominal ultrasonography] good at [ruling in or ruling out appendicular disease]?
The Cochrane Library Issue 1 2007. Appendicitis[MeSH explode all trees] AND Pregnancy [MeSH explode all trees] 0 results. Medline 1950 to February Week 2 2007. Embase 1980 to 2007 Week 08. Using the OVID interface [appendicitis.mp. or exp Appendicitis/] OR [exp Ultrasonography/or ultrasonography.mp. OR ultrasound.mp. OR sonography.mp.] AND [exp Pregnancy/OR exp Pregnancy Complications/OR exp Pregnancy, Abdominal/OR pregnancy.mp.] Limit to English language and Human. Diagnosis Clinical Query filter (specificity)
Ten papers were found, of which seven were irrelevant or of insufficient quality for inclusion. The three remaining papers are shown in table 11.
The results of these studies need to be viewed with caution. All suffer from the handicap of small numbers, likely selection biases and the absence of a gold standard. The analysis of the third study is seriously flawed in that indeterminate scans are not included.
A positive USS may be useful in the diagnosis of acute appendicitis during pregnancy. Those patients with a negative scan should be further investigated and observed until the symptoms resolve or an alternative diagnosis is reached.