Pregnant Patients Requiring Emergency General Surgery: Diagnostic and Management Strategies
From the Department of Surgery, University of Toronto, and affiliated institutions, this scoping review examines the care of pregnant patients requiring emergency general surgery (EGS).
About 1%–2% of pregnant patients develop conditions that require emergency general surgery (EGS). The diagnosis and management of these conditions can be challenging, as surgeons must carefully balance the needs of the pregnant patient and the developing fetus. We sought to summarize the latest literature guiding surgical management of appendicitis, benign biliary disease, bowel obstruction, and hemorrhoids in pregnant patients.
Risks and Clinical Outcomes
Acute appendicitis, benign biliary disease, and bowel obstructions confer increased risk of adverse maternal and fetal obstetrical outcomes. Research indicates that nonoperative treatment of each of these diseases can result in significant maternal, and possibly fetal, morbidity. Furthermore, nonoperative or delayed operative management often increases adverse obstetrical events, including death.
Disease-Specific Management
A thoughtful approach is crucial for surgeons and institutions caring for pregnant patients with EGS diseases. In general, treatment should be similar to that in nonpregnant patients, with some important considerations and modifications. Key strategies include:
- Appendicitis and Cholecystitis: In general, pregnant patients with acute appendicitis and cholecystitis should undergo appendectomy or cholecystectomy, respectively.
- Biliary Colic: The management of biliary colic has significant nuance depending on trimester. While an operative approach is favoured in the first 2 trimesters, the role of surgery in the third trimester is less clear.
- Bowel Obstruction: Operative management of bowel obstruction must be determined on a case-by-case basis.
Surgical Approach
In all instances, a laparoscopic approach is preferred, if feasible. This guidance is based on a comprehensive scoping review using OVID Medline for articles published between January 2000 and June 2023 pertaining to EGS and pregnancy.