Location of the Appendix in the Gravid Patient

Background

Several studies have attempted to support or dispel the teaching of appendix movement away from the right lower quadrant (RLQ) during pregnancy with contradictory results.

Objective

This study investigated the location of the appendix in the gravid patient in an emergency department (ED) setting using computed tomography (CT).

Methods

This was a retrospective chart review of consecutive gravid patients presenting to the ED for trauma who required abdominal CT. The patient population was obtained using the Vidant Medical Center Trauma Registry from January 1, 2000 to December 31, 2006. The abdomen was divided into nine regions using the mid-clavicular lines, superior anterior iliac spine, and umbilicus. A single Board-certified radiologist determined the region location of the appendix.

Results

Forty-five patients were identified and 35 were studied. Ten patients were excluded due to appendix not identified, unknown gestational age, or inability to review the CT study. In 21 of 22 third-trimester pregnancies, the appendix was not found in the right lower region (RLR), which corresponded to the RLQ. All 11 patients in the second trimester did not have the appendix in the RLR. Two patients were identified in the first trimester and neither appendix was found in the RLR.

Conclusions

The appendix in the gravid patient was not found in the RLR with increasing frequency as pregnancy progressed.