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CT Scan Improves Certainty of Diagnosis in the Pregnant Patient
Stephen J Ferzoco, Matt Pappas, Ali Tavakkolizadeh, Stephen Ledbetter, David I Soybel
Brigham and Women's Hospital, Boston, MA
Objective: Appendicitis is the single most common abdominal emergency during pregnancy, affecting roughly 1 in 1440 pregnancies and definitive diagnosis can be challenging in these patients. Reluctance to the use of CT scans in pregnancy has diminished over time and surgeons are now realizing that CT can play a role in aiding in the diagnosis of abdominal pain as well as directing therapy. We sought to determine if CT scan could accelerate the diagnosis and improve the accuracy of appendicitis in the pregnant patient.
Design: Retrospective review
Setting: Records at the Brigham and Women’s Hospital, a tertiary care hospital.
Patients: We reviewed the records of 97 pregnant patients between 1997 and 2006 with suspicion for appendicitis who underwent CT imaging.
Main Outcome Measurements: Review of CT scan results as well as pathology results of those undergoing surgery
Results: Of the 97 patients who underwent a CT scan of the abdomen and pelvis, 13 (13.4%) were found to have radiographic evidence of appendicitis. Of those 13 patients who had positive radiographic signs, 12 (92.3%) were found to have pathologically confirmed appendicitis. Of note, three patients who had negative CT scans underwent appendectomy and had a pathologically normal appendix. When the CT scans were negative for appendicitis 84 of 97 (86.6%), intra-abdominal pathology was noted in 27 of the 84 patients (32.15)
Conclusion: CT scan can help accelerate the diagnosis and improve the accuracy of appendicitis in the pregnant patient. When negative for appendicitis, CT can still provide valuable information to the clinician regarding diagnosis and help direct therapy. Our study also helps to define the criteria to develop a prospective randomized trial.
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