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Milotić, Mario; Miljas, Luciana; Grbas, Vilma; Grbas, Harry
Medicina Fluminensis, 12/2019, Volume: 55, Issue: 4Journal Article
Akutni apendicitis jedan je od najčešćih uzroka razloga indiciranja neopstetričkog operativnog zahvata u trudnica. Iako se može prezentirati klasičnom kliničkom slikom, u trudnoći je zbog fizioloških i anatomskih promjena atipična slika češća. To čini dijagnozu ovog stanja kompliciranom te ona zahtijeva osim kliničkog pregleda i daljnje pretrage. One uključuju diferencijalnu krvnu sliku i CRP te slikovne pretrage. Činjenica da leukocitoza u trudnoći ne predstavlja patologiju te da CRP može pokazivati tendenciju rasta potvrđuje da ove metode nisu pretjerano uspješne. Od slikovnih pretraga najbolja se pokazala magnetska rezonancija, ali je njezina dostupnost ograničena. Liječenje se provodi kirurški, pri čemu postoje različiti pristupi. Iako postoje brojni radovi koji preferiraju otvorenu nad laparoskopskom apendektomijom, novija istraživanja pokazuju kako nema značajnih rizika za majku i fetus kod korištenja laparoskopskog pristupa. U novije se doba spominje i konzervativni način liječenja antibioticima, ali zbog mogućih komplikacija on se izbjegava, osim u slučajevima nedostupne kirurške skrbi. Akutni apendicitis je stanje koje treba brzo riješiti kako bi se izbjegle komplikacije koje u nekim slučajevima mogu izazvati značajne posljedice za majku i dijete. U članku je prikazan cjelovit pristup trudnici s apendicitisom uz korištenje najnovije literature. Acute appendicitis (AA) is one of the most common non-obstetric indications for surgery in pregnant women. Even though it can present with a typical set of symptoms, in pregnancy due to the physiological and anatomical changes, an atypical presentation is more common. This makes the diagnosis of AA very complicated and it requires additional exams which include a blood work, CRP and imaging studies. Since leucocytosis and increased levels of CRP are physiological finding in pregnancy, those tests are not very helpful. MRI is the best imaging test in this situation, but its availability is limited. The treatment is surgical, and it includes two approaches: open appendectomy (OA) or laparoscopic appendectomy (LA). Even though many studies that predilect OA can be found, recent discoveries indicate that there is no statistically significant difference in the risk for the mother and foetus between the two approaches. Some studies introduce a non-operative approach as a valuable substitution for a surgical approach in case of AA especially in the areas where surgical care is limited or unavailable. AA in pregnancy is a condition that must be recognized and treated as soon as possible in order to avoid severe complications for the mother and the child. This review gives an integral approach to a pregnant woman with appendicitis, and it’s based on the latest published literature.
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