Evaluation of the Anatomical Position of Appendix in the Gravid Patients

Introduction & It is believed that the appendix location changes with the growing of uterus during pregnancy. Therefore، it is expected that pregnant patients with acute appendicitis، pain and tenderness shif to the superolateral part of abdominal cavity. This can affect both the diagnostic and surgical approach to the acute appendicitis of these patients. A descriptive study was carried out over 240 pregnant women. During laparotomy and cesarean section anatomical position of the appendix was evaluated with respect to the Mcburney point and incision. The patients were grouped into A (full term with gestational age > 37 weeks) and B (preterm with gestational age 20-37 weeks). Also anatomical location of the appendix evaluated in 50 other men and non pregnant women as control group. Comparison of anatomical location of the appendix and cecum in 240 studied patients in their respect to the 50 patients in the control group revealed no significant statistical difference with chi square test. In 188 (78. 3%) patients the appendix was located in the limit of Mcburney point and incision. In 52 patients (21. 7%) the anatomical location of the appendix had been changed to Subheptic space (28 Case) and right flank (24 cases). In 46 patients، the location of the cecum was at subheptic and right flank. Gross change of the appendix position toward the upper and lateral part of the peritoneal cavity was seen only in 6 patients. No statistical analysis difference was seen on the change of appendix location between 223 full term and 17 preterm pregnant patients relative to the 50 patients of the control group. Usually، the anatomical position of the appendix does not change with the growing of uterus during pregnancy. Therefore، Mcburney point and right lower quadrant is the landmark location in simple acute appendicitis for both clinical diagnosis and surgical approach.