Acute Appendicitis During Pregnancy: A Seven-Year Retrospective Case Series at a United Kingdom Tertiary Hospital

Background Acute appendicitis is the most common surgical problem encountered during pregnancy. Our case series was conducted to evaluate the clinical presentation, diagnosis, management, and outcomes of acute appendicitis in pregnant women. Methods A retrospective analysis of nine pregnant women diagnosed with acute appendicitis at James Cook University Hospital, United Kingdom, from 2017 to 2024 was conducted. Patients were evaluated according to age, clinical presentation, gestational age, diagnostic modalities, histopathology, time interval from admission to surgery, type of surgery, outcomes, and complications. Results The mean age was 26.6 years. Cases occurred in the first trimester (n = 1/9, 11.1%), second trimester (n = 3/9, 33.3%), third trimester (n = 4/9, 44.4%), and postpartum period (n = 1/9, 11.1%). Right iliac fossa pain was the most common presentation. WBC counts and CRP levels were elevated in all cases. Imaging was used to support the diagnosis in 7/9 patients (77.8%). Ultrasound was performed in 5/9 patients (55.6%), yielding positive findings in 1/5 (20.0%), inconclusive findings in 1/5 (20.0%), and false-negative findings in 3/5 (60.0%). MRI was performed in 7/9 patients (77.8%) and identified appendicitis in all clinically suspected cases, although 2/5 examinations (40.0%) were subsequently considered false-positive. The mean interval from presentation to surgery was 3.4 days. All patients (n = 9/9, 100%) underwent surgery, including laparoscopic appendicectomy in 6/9 (66.7%) and open appendicectomy in 3/9 (33.3%). Histopathological confirmation of acute appendicitis was obtained in 5/9 cases (55.6%). The negative appendicectomy rate was 4/9 (44.4%). Complications among confirmed cases included peritonitis in 5/9 patients (55.6%), sepsis in 2/9 (22.2%), perforation in 1/9 (11.1%), and preterm labour in 1/9 (11.1%). Conclusion Our case series demonstrates the continued challenges in the accurate and timely diagnosis of acute appendicitis, coupled with a reluctance to operate on pregnant women, which leads to delays in surgical intervention, thereby increasing the risk of complications. The surgical approach (laparoscopic/open) did not change outcomes. MRI demonstrates superior diagnostic reliability; however, despite advances in diagnostic modalities, the negative laparotomy rate remains high during pregnancy.