Appendectomy in pregnancy: the experience of a university hospital.

The files of pregnant patients who underwent appendectomy at our hospital over the period 1977-96 were studied retrospectively. Forty-six patients were operated upon amongst 52 108 deliveries over this period. Of those 27 had uncomplicated acute appendicitis and six had one of the complications of acute appendicitis (a prevalence of 0.063%). Thirteen had normal appendices (71.7% accuracy). Obstetric complications occurred in four patients, with three fetal losses (6.5%). Those with complicated appendicitis had significantly delayed presentation, in-hospital delay and prolonged postoperative stay. Recently we used diagnostic laparoscopy in two patients for diagnosis and to perform appendectomy in one. In conclusion, the incidence of acute appendicitis in pregnancy seems to be the same over the period of gestation and the diagnostic accuracy seems to be related both to the late presentation by the patient and to physician delay. Maternal morbidity and fetal loss are mostly limited to those with complicated appendicitis.

True caecal diverticulitis.

Nine patients (six females and three males), median age = 27.5 years (range 13-36) with caecal diverticulitis are presented. All underwent surgery with a suspected diagnosis of acute appendicitis. Per-operative diagnosis was possible in five cases, two cases were thought to have other benign pathology, but malignancy could not be excluded in the remaining two cases. Local excision was carried out in five cases, a right hemicolectomy was performed in the rest. Histology showed true diverticuli in eight cases, severity of the inflammation made it difficult to comment on the ninth case. Postoperative barium enema was carried out in six cases, which showed no further diverticuli in the colon. We conclude that preoperative diagnosis of caecal diverticulitis is difficult, and that true solitary caecal diverticuli present in a younger age group than the false caecal and ascending colon diverticuli and that they are probably congenital in origin.

Postpartum pain due to thrombosed varicose veins of the round ligament of the uterus.

Postpartum thrombosis of varicose veins of the round ligament may present in a clinical picture similar to an irreducible inguinal hernia. Two such unusual cases are reported. One patient underwent surgery while the other, with a presumptive diagnosis of the same condition, was observed, with no complications occurring in both patients. This condition has not to my knowledge been previously reported. The increased incidence of both varicose veins and thrombosis in the postpartum period should alert the physician to the diagnosis of such conditions.

Volvulus of the sigmoid colon in Jordan.

This report discusses 27 patients with sigmoid volvulus treated at Jordan University Hospital (JUH) during a 15-year period. These patients represented 4.7 percent of adult patients treated for intestinal obstruction in the same period. The average age was 54.5 years, and none of the patients was institutionalized. Twenty-five patients presented with acute symptoms, and two had chronic symptoms. Sigmoidoscopic detorsion was achieved in 15 patients. Emergency resection was required in two of these patients: for the development of gangrene a few hours after detorsion in one patient and for recurrence within 24 hours in the other despite the presence of a rectal tube. Early recurrence occurred in two other patients and was managed endoscopically. Emergency surgery was performed in 10 other patients: for a failed endoscopic detorsion in three patients, for ulcerated and bleeding mucosa forecasting gangrene in another, and as a primary treatment in six patients who were either misdiagnosed or suspected to have gangrenous bowel. Elective resection was performed in 13 patients. The mortality rate was 15 percent (4/27) for the whole series and 33.3 percent (1/3) for those with gangrenous bowel.