4. PerforationNonPregnant:4-19%Pregnant:Highest in 3rd T1st T: 8%2nd T: 12%3rd T: 20%(AnderssonandLambe,2001;Ueberrueckandassociates,2004)Surgery delayed by >24 hrs from presentation: 66%riskofperforation:Surgery within 24 hrs of presentation withsymptoms:Noperforation(Tamiretal, 1999)
4. Perforation Non Pregnant: 4 -19% Pregnant: Highest in 3rd T 1 st T: 8% 2 nd T: 12% 3 rd T: 20% (Andersson and Lambe, 2001; Ueberrueck and associates ,2004) Surgery delayed by >24 hrs from presentation: 66% risk of perforation: Surgery within 24 hrs of presentation with symptoms: No perforation (Tamir et al, 1999)
Non-perforated appendix: Fetal mortality: 1.5%: Mat mortality: 0.1%Perforated appendix: Fetal mortality: 5.1%-20%: Maternal mortality: 1% (diffuse peritonitis): Preterm contractions: {localized peritonitis)83%(AugustinandMajerovic,2006)o Neonatal neurological injury [Sepsis)(Mays et, 1995)
• Non-perforated appendix • Fetal mortality: 1.5% • Mat mortality: 0.1% • Perforated appendix • Fetal mortality: 5.1%-20% • Maternal mortality: 1% {diffuse peritonitis} • Preterm contractions: {localized peritonitis} 83% (Augustin and Majerovic, 2006). o Neonatal neurological injury {Sepsis} (Mays et,1995)
DiagnosisMantrels scoreDifficultSymptomsSignsLabImaging
Diagnosis Mantrels score Difficult Symptoms Signs Lab Imaging
Alvarado scoreforappendicitisNonPregnantScoreSymptoms1Migratoryrightiliacfossapain1Nausea/Vomiting1AnorexiaSigns2Tenderness inrightiliacfossa1Rebound tenderness in right iliac fossa5-6→Possible1ElevatedtemperatureLaboratoryfindings7-8Probable2Leucocytosis1Shiftto theleft of neutrophils>9→Very10probableTotalMANTRELSMigratoryright iliacfossapainAnorexia,NauseaNomitingTenderness in theright iliacfossaReboundpainElevatedtemperatureLeukocytosisShiftofleukocstotheleftofneutrophils
MANTRELS Migratory right iliac fossa pain Anorexia, Nausea/Vomiting Tenderness in the right iliac fossa Rebound pain Elevated temperature Leukocytosis Shift of leukocytes to the left of neutrophils Non Pregnant
Pregnant:More difficult1.Nausea, vomiting, anorexia accompany normalpregnancy.2. Uterus enlarges: appendix commonly movesupwardandoutward:pain&tenderness are"displaced" (Baer et al, 1932)challenged (Mourad et al, 2000)3. Peritoneal signs often absent [lifting of abdominalwall by uterus)May not have typical symptom esp. in latepregnancy4. Fever in less than majority
Pregnant: More difficult. 1. Nausea, vomiting, anorexia accompany normal pregnancy. 2. Uterus enlarges: appendix commonly moves upward and outward: pain& tenderness are "displaced" (Baer et al, 1932). challenged (Mourad et al, 2000). 3. Peritoneal signs often absent {lifting of abdominal wall by uterus} May not have typical symptom esp. in late pregnancy 4. Fever in less than majority