The use of helical computed tomography in pregnancy for the diagnosis of acute appendicitis.
OBJECTIVE
Accurate diagnosis of acute appendicitis in pregnancy by clinical evaluation is difficult. A safe, reliable test was sought to decrease a delay in diagnosis and to avoid unnecessary invasive procedures. A helical or spiral computed tomographic technique has proven to be a very accurate test in the nonobstetric population for the identification of acute appendicitis. We report its use in pregnant patients with suspected acute appendicitis.


METHODS
All pregnant patients who were undergoing helical computed tomography at our institution from April 1997 to February 1998 for the suspected clinical diagnosis of acute appendicitis were retrospectively reviewed. Helical computed tomography was performed by standard departmental protocol. A positive study was reported if an enlarged appendix, which did not fill with contrast material, was present with periappendiceal inflammatory changes. Outcomes were determined by the results of surgery and pathologic examination or clinical follow-up.


RESULTS
Seven patients were identified in the study period. Two patients had positive findings on helical computed tomography, and acute appendicitis was confirmed at laparotomy and by pathologic inspection. There were no further prenatal complications and both patients delivered at term. Five patients had a normal-appearing appendix on helical computed tomography, and all of these patients had resolution of their pain and symptoms.


CONCLUSIONS
Helical computed tomography appears to be a useful, noninvasive test to accurately diagnose acute appendicitis in pregnancy.
Ames Castro
M
M
Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, Massachusetts, USA.
Shipp
T D
TD
Castro
E E
EE
Ouzounian
J
J
Rao
P
P
D000328:Adult; D001064:Appendicitis / Q000175:diagnosis*; D003287:Contrast Media; D005260:Female; D006801:Humans; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*
D003287:Contrast Media