European Journal of Molecular & Clinical Medicine

Background: Acute Appendicitis is the most common non obstetric surgical emergency during pregnancy that can occur throughout pregnancy but difficulty in diagnosis and delayed treatment can be associated with adverse maternal and pregnancy outcome.
Patients and Method: A prospective, observational study conducted in the Department of General Surgery at Baquba Teaching Hospital – Diyala – Iraq, from April 2016 to April 2020. Seventeen pregnant women, with acute appendicitis, were included.The patients' age ranged from 19 - 39 years with a mean age of 25 years. The patients' history, operative findings, postoperative outcome and histopathology results were recorded and analyzed.
Result: Four patients were in the first trimester, 8 patients were in the second trimester while 5 patients were in the third trimester. Abdominal pain was the main symptoms in all patients followed by poor appetite and nausea, while the main physical signs were tenderness and rebound tenderness in right lower quadrant of the abdomen. The appendix was grossly inflamed in 16 patients and was normal in one patient as proved by histopathology. During the follow up period, 3 patients had surgical site infection (SSI) and treated conservatively, 2 patients had preterm contractions and treated by tocolytic drugs, while fetal loss occurred in one patient.
Conclusion: Acute appendicitis is a common surgical emergency during pregnancy but high degree of suspicion and skills are required for early diagnosis with subsequent proper management to avoid possible complications both to the fetus and the mother

- Baquba Teaching Hospital – Diyala – Iraq, from January 2017 to December 2019. A total of 2749 patients of all age groups and both sexes who were found to have symptomatic gallstones were included in the study. Operative findings, causes of conversion and postoperative complications were recorded.
Result: Out of the 2749 patients who were included in this study, successful laparoscopic cholecystectomy was completed in 2711 patients, while conversion to open procedure was required in 38 patients (1.38 %). Among those who were converted to open surgery, the most common cause of conversion was dense adhesions around the gallbladder representing 42.1 % of causes of conversion.The next common cause of conversion was obscure anatomy at Calot's triangle in 31.58 % patients. Instrument failure was responsible for 10.53 % of conversions. Massive bleeding that could not be controlled laparoscopically was the cause of conversion in 7.89 % of patients and visceral injury was the cause in 5.26 % while the least common cause of conversion was wide cystic duct in 2.63% which was difficult to clip laparoscopically.
Conclusion: The risk of conversion to open surgery is always present and the decision about when to convert to laparotomy is an individual one, often subjective, made by the surgeon in the course of the procedure. The conversion rate in the present study was 1.38 % which is in the lower limit as compared to other studies, with causes similar to or approximating many national and international literatures.