Acute appendicitis, appendectomy and female fertility: an assessment of the problem
Milyukov V.Ye., Bartosh N.O., Brileva E.A., Zakirova D.R.
The medical and social significance of the problems associated with the development of acute appendicitis is due to its high prevalence. Appendectomy is one of the most common surgical procedures performed on women of reproductive age, largely due to overdiagnosis and unnecessary surgeries. Inflammation and surgical intervention in the pelvis lead to adhesive disease which can cause a decrease in female fertility by affecting the patency of the fallopian tubes, the mobility of the fimbria, and the physiological function of the ovary.
The article addresses the issues of pathogenesis and diagnosis of acute appendicitis, as well as the influence of appendectomy on topographic anatomical and physiologic changes in the reproductive system of a woman. The literature on the relationship between the phases of the menstrual cycle and acute appendicitis was reviewed. The anatomical connection of the appendix and the right ovary through the ligamentum appendiculoovaricum (of Clado) explains the generalization of infection and the possibility of hematogenous and lymphogenous spread of the inflammatory process from the appendix to the ovary and vice versa. It is possible that dissection of the ligamentum appendiculoovaricum during appendectomy leads to impaired function of the right ovary due to decreased blood supply, therefore, the risk of infertility may be significantly increased. It has been shown that due to the close location and direct anatomical and physiological connection of the appendix and the internal organs of the female reproductive system, appendicular-genital syndrome often develops during appendicitis and/or appendectomy which dramatically increases the risk of infertility.
Conclusion: Appendectomy leads to reduced female fertility by affecting the patency of the fallopian tubes and mobility of the fimbriae, decreasing mucus secretion into the fallopian tube lumen and causing fibrosis of the ovarian capsule. Given the specific anatomical structure of the female reproductive system, it is necessary for a woman to consult a gynecologist and a surgeon together in case of acute abdominal conditions.
Authors’ contributions: Milyukov V.Ye. – developing the concept of the article; Brileva E.A., Zakirova D.R. – collecting and processing the material; Brileva E.A. – writing the text; Bartosh N.O., Milyukov V.Ye. – editing the text. All authors made a significant contribution to the preparation of the manuscript, read and approved the final version before its publication.
Conflicts of interest: Authors declare lack of the possible conflicts of interests.
Funding: The study was conducted without sponsorship.
For citation: Milyukov V.E., Bartosh N.O., Brileva E.A., Zakirova D.R. Acute appendicitis,
appendectomy and female fertility: an assessment of the problem.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2024; (7): 150-156 (in Russian)
https://dx.doi.org/10.18565/aig.2024.121
Keywords
acute appendicitis
adhesions
infertility
appendicular-genital syndrome
ovulatory syndrome
ligamentum appendiculoovaricum (of Clado)
References
- Маховский В.З., Аксененко В.А., Маховский В.В., Аксененко Д.В., Куюмчева К.К., Юрин С.В. Неотложные сочетанные операции при остром аппендиците и кистозных образованиях малого таза. Хирургия. Журнал им. Н.И. Пирогова. 2022; 2: 30‑7. [Makhovsky V.Z., Aksenenko V.A., Makhovsky V.V., Aksenenko D.V., Kuyumcheva K.K., Yurin S.V. Emergency combined surgery for acute appendicitis and cystic lesions of small pelvis. Pirogov Russian Journal of Surgery. 2022; (2): 30‑7. (in Russian)]. https://dx.doi.org/10.17116/hirurgia202202130.
- Министерство здравоохранения Российской федерации. Клинические рекомендации. Острый аппендицит у взрослых. 2023. [Ministry of Health of the Russian Federation. Clinical guidelines. Acute appendicitis in adults. 2023. (in Russian)].
- Позднякова Е.В., Стяжкина С.Н. Дифференциальная диагностика острого аппендицита клинический случай. Столица науки. 2020; (4): 163-70. [Pozdnyakova E.V., Styazhkina S.N. Differential diagnosis of acute appendicitis. clinical case. Stolica nauki. 2020; (4): 163-70. (in Russian)].
- Parente G., Di Mitri M., D'Antonio S., Cravano S., Thomas E., Vastano M. et al. Pelvic health assessment in adult females eollowing pediatric appendicitis: a monocentric retrospective case-control study. Children (Basel, Switzerland). 2022; 9(3): 346. https://dx.doi.org/10.3390/children9030346.
- Bhangu A.; RIFT Study Group on behalf of the West Midlands Research Collaborative. Evaluation of appendicitis risk prediction models in adults with suspected appendicitis. Br. J. Surg. 2020; 107(1): 73-86. https://dx.doi.org/10.1002/bjs.11440.
- Ezem U. Corpus luteum rupture mimicking acute appendicitis. Ibom Medical Journal. 2022: 15(3). https://dx.doi.org/10.61386/imj.v15i3.275.
- Aziz W.M., Fawzi H.A. Acute appendicitis versus ruptured ovarian cyst in female patients presented as acute abdomen pain. Indian Journal of Public Health Research and Development. 2019; 10(1): 364-7. https://dx.doi.org/10.5958/0976-5506.2019.00072.X.
- Merlino L., Chiné A., Carletti G., Del Prete F., Pisanelli M.C., Titi L. et al. Appendectomy and women’s reproductive outcomes: a review of the literature. Eur. Surg. 2021; 53: 281-6. https://dx.doi.org/10.1007/s10353-021-00703-1.
- Тимербулатов Ш.В., Тимербулатов М.В., Федоров С.В., Гафарова А.Р., Тимербулатов В.М., Сибаев В.М. Острый аппендицит: как часто выполняется «напрасная» аппендэктомия? Креативная хирургия и онкология. 2023; 13(2): 112-8. [Timerbulatov Sh.V., Timerbulatov M.V., Fedorov S.V., Gafarova A.R., Timerbulatov V.M., Sibaev V.M. Acute appendicitis: how often is appendectomy negative? Creative Surgery and Oncology. (in Russian)]. https://dx.doi.org/10.24060/2076-3093-2023-13-2-112-118.
- Arnbjörnsson E. Varying frequency of acute appendicitis in different phases of the menstrual cycle. Surg. Gynecol. Obstet. 1982; 155(5): 709-11.
- Perrone G., Petracca G.L., Prioriello C., Morini A., Bonati E., Disisto C. et al. Acute abdomen in woman of childbearing age: appendicitis or pelvic inflammatory disease? A systematic review. Biomed. J. Sci. & Tech. Res. 2021; 35(4): 27900-6. https://dx.doi.org/10.26717/BJSTR.2021.35.005738.
- Singh T.B., Kumar R., Nigam A., Devi T. An observational study to find relationship of acute appendicitis to menstruation cycle in Northern and Northeastern part of India. Int. J. Med. Med. Res. 2022; 8(1): 37-43. https://dx.doi.org/10.11603/ijmmr.2413-6077.2022.1.13083.
- Шидаков И.Х. Диагностика и лечение первичного пельвиоперитонита у детей в Карачаево-Черкесской Республике. Трудный пациент. 2020; 18(5): 25-8. [Shidakov I.H. Diagnosis and treatment of primary pelvioperitonitis in children in the Karachay-Cherkess Republic. Difficult Patient. 2020; 18(5): 25-8. (in Russian)]. https://dx.doi.org/10.24411/2074-1995-2020-10034.
- Bouali M., El Berni Y., Moufakkir A., El Bakouri A., El Hattabi K., Bensardi F. et al. Value of Alvarado scoring system in diagnosis of acute appendicitis. Ann. Med. Surg. (Lond). 2022; 77: 103642. https://dx.doi.org/10.1016/j.amsu.2022.103642.
- Щеглов Э.А., Гуляева П.С. Актуальность применения шкалы Альварадо в диагностике острого аппендицита (на примере пациентов больницы скорой медицинской помощи города Петрозаводска). Наука. Общество. Оборона. 2018; 2(15). [Shcheglov E.A., Gulyaeva P.S. The relevance of the use of the Alvarado scale in the diagnosis of acute appendicitis (on the example of patients of the emergency hospital of the city of Petrozavodsk). Science. Society. Defense. 2018; 2(15). (in Russian)]. https://dx.doi.org/10.24411/2311-1763-2018-10153.
- Awayshih M.M.A., Nofal M.N., Yousef A.J. Evaluation of Alvarado score in diagnosing acute appendicitis. Pan. Afr. Med. J. 2019; 34: 15. https://dx.doi.org/10.11604/pamj.2019.34.15.17803.
- Yılmaz E.M., Kapçı M., Çelik S., Manoğlu B., Avcil M., Karacan E. Should Alvarado and Ohmann scores be real indicators for diagnosis of appendicitis and severity of inflammation? Ulus. Travma Acil Cerrahi Derg = Turkish journal of trauma & emergency surgery: TJTES. 2017; 23(1): 29-33. https://dx.doi.org/10.5505/tjtes.2016.89894.
- Durai R., Ng P.C. Mittelschmerz mimicking appendicitis. Br. J. Hosp. Med. (Lond). 2009; 70(7): 419. https://dx.doi.org/1010.12968/hmed.2009.70.7.43133.
- Brott N.R., Le J.K. Mittelschmerz. 2023 May 1. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan. 2023 May 1.
- Wei L., MacDonald T., Shimi S. Association between appendicectomy in females and subsequent pregnancy rate: a cohort study. Fertil. Steril. 2012; 98(2): 401-5. https://dx.doi.org/10.1016/j.fertnstert.2012.05.016.
- Симрок В.В., Попова И.А., Мельникова Д.В. Клинико-патогенетическое обоснование противоспаечной терапии при аппендикулярно-генитальном синдроме у женщин репродуктивного возраста. РМЖ. Мать и дитя. 2020; 3(4): 228-32. [Simrok V.V., Popova I.A., Mel’nikova D.V. Clinical pathogenic basis for anti-adhesive treatment for appendicular-genital syndrome in women of reproductive age. Russian Journal of Woman and Child Health. 2020; 3(4): 228-32. (in Russian)]. https://dx.doi.org/10.32364/2618-8430-2020-3-4-228-232.
- Ермакова Н.П., Елисеев А.В. Состояние менструальной функции и изменения гинекологического статуса у девочек, перенесших острый аппендицит. Мать и дитя в Кузбассе. 2001; 2(3): 48-50. [Ermakova N.P., Eliseev A.V. The state of menstrual function and changes in gynecological status in girls who underwent acute appendicitis. Mother and Child in Kuzbass. 2001; 2(3): 48-50. (in Russian)].
- Шнайдер И.С., Цап Н.А. Гинекологические заболевания у детей и подростков при синдроме «острого живота». Детская хирургия. 2020; 24(6): 377-82. [Schneider I.S., Tsap N.A. Gynecological diseases in children and adolescents with the acute abdomen syndrome. Russian Journal of Pediatric Surgery. 2020; 24(6): 377-82. (in Russian)]. https://dx.doi.org/10.18821/1560-9510-2020-24-6-377-382.
- Macedo M., Kim B., Khoury R., Narkiewicz L. A rare case of right lower quadrant abdominal pain. Am. J. Emerg. Med. 2017; 35(4): 668.e1-668.e2. https://dx.doi.org/1010.1016/j.ajem.2016.11.012.
- Amponsah-Manu F., Ssentongo P., Arkorful T., Ofosu-Akromah R., Ssentongo A.E., Hansen-Garshong S. et al. Imperforate hymen and leaking hematosalpinx mimicking acute appendicitis: A report of a rare case and a review of literature. Int. J. Surg. Case Rep. 2019; 63: 69-74. https://dx.doi.org/1010.1016/j.ijscr.2019.09.003.
- Петухов В.А., Нечай Т.В., Ивахов Г.Б., Лобан К.М., Насыров М.Р., Шининов А.Н., Сажин А.В. Ранние внутрибрюшные осложнения лапароскопической аппендэктомии: статус-кво и перспектива профилактики. Эндоскопическая хирургия. 2022; 28(6): 64‑75. [Petukhov V.A., Nechay T.V., Ivakhov G.B., Loban K.M., Nasyrov M.R., Shininov A.N., Sazhin A.V. Early intraabdominal complications after laparoscopic appendectomy: the status quo and the prospects for prevention. Endoscopic Surgery. 2022; 28(6): 64‑75.(in Russian)]. https://dx.doi.org/10.17116/endoskop20222806164.
- Хасанов А.Г., Суфияров И.Ф., Бадретдинова Ф.Ф., Меньшиков А.М., Ибатуллин Э.Р. Некоторые диагностические и лечебные аспекты при аппендикулярных инфильтратах. Креативная хирургия и онкология. 2019; 9(3): 182-7. [Khasanov A.G., Sufiyarov I.F., Badretdinova F.F., Menshikov A.M., Ibatullin E.R. Some aspects of diagnosis and treatment of appendicular infiltration. Creative Surgery and Oncology. 2019; 9(3): 182-7. (in Russian)]. https://dx.doi.org/10.24060/2076-3093-2019-9-3-182-187.
- Кохреидзе Н.А., Леонтьева С.А. Клиническая неоднозначность определения онкомаркеров в дифференциальной диагностике новообразований придатков матки воспалительной этиологии у девочек. Педиатр. 2015; 6(1): 115-9. [Kokhreidze N.A., Leont'yeva S.A. Clinical ambiguousness of measurement of tumor markers in the differential diagnosis of the uterus appendages tumors and inflammatory pelvic mass in girls. Pediatrician (St. Petersburg). 2015; 6(1): 115-9. (in Russian)].
- Безнощенко Г.Б., Кравченко Е.Н., Цыганкова О.Ю., Кропмаер К.П., Кузьменко Е.В. Оперированный орган и репродуктивные проблемы. Мать и дитя в Кузбассе. 2020; 2(81): 10-4. [Beznoshchenko G.B., Kravchenko E.N., Tsygankova O.Yu., Kropmaer K.P., Kuz’menko E.V. Operated organ and reproductive problems. Mother and Child in Kuzbass. 2020; 2(81):10-4.(in Russian)]. https://dx.doi.org/10.24411/2686-7338-2020-10015.
- Limberg J., Ginsburg H., Lala S., Tomita S. Recurrent pelvic infections and salpingitis after appendicitis. J. Pediatr. Adolesc. Gynecol. 2015; 28(6): e177-e8. https://dx.doi.org/10.1016/j.jpag.2015.04.003.
- Кулавский В.А., Зиганшин А.М., Кулавский Е.В. Клинические аспекты профилактики спаечного процесса при острых воспалительных заболеваниях органов малого таза у женщин. Акушерство и гинекология. 2019; 2: 14-20. [Kulavsky V.A., Ziganshin A.M., Kulavsky E.V. Prevention of adhesion in women with acute pelvic inflammatory diseases: clinical aspects. Obstetrics and Gynecology. 2019; (2): 14-20. (in Russian)]. https://dx.doi.org/10.18565/aig.2019.2.14-20.
- Thompson W.M., Lynn H.B. The possible relationship of appendicitis with perforation in childhood to infertility in women. J. Pediatr. Surg. 1971; 6(4): 458-61. https://dx.doi.org/10.1016/s0022-3468(71)80008-8.
- Mueller B.A., Daling J.R., Moore D.E., Weiss N.S., Spadoni L.R., Stadel B.V. et al. Appendectomy and the risk of tubal infertility. N. Engl. J. Med. 1986; 315(24): 1506-8. https://dx.doi.org/1010.1056/NEJM198612113152402.
- Margaux Becker V., Silver S., Seufert R., Muensterer O.J. The association of appendectomy, adhesions, tubal pathology, and female infertility. JSLS. 2019; 23(1): e2018.00099. https://dx.doi.org/1010.4293/JSLS.2018.00099.
- Elraiyah T., Hashim Y., Elamin M., Erwin P.J., Zarroug A.E. The effect of appendectomy in future tubal infertility and ectopic pregnancy: a systematic review and meta-analysis. J. Surg. Res. 2014; 192(2): 368-374.e1. https://dx.doi.org/10.1016/j.jss.2014.08.017.
- Jabbar A.K., AbdulWahab A.Y., Alhakeema B.H. 3-The influence of different phases of menstrual cycle on the diagnosis of acute appendicitis, a prospective study. Basrah Journal of Surgery. 2007; 13(1): 1-10. https://dx.doi.org/10.33762/bsurg.2007.56230.
- Robinson J.A., Burch B.H. An assessment of the value of the menstrual history in differentiating acute appendicitis from pelvic inflammatory disease. Surg. Gynecol. Obstet. 1984; 159(2): 149-52.
- Eldar S., Faraggi D., Abrahamson J., Schein M. The menstrual cycle and acute appendicitis. Eur. J. Surg. 1995; 161(12): 897-900.
- Abbasi N., Patenaude V., Abenhaim H.A. Management and outcomes of acute appendicitis in pregnancy-population-based study of over 7000 cases. BJOG. 2014; 121(12): 1509-14. https://dx.doi.org/10.1111/1471-0528.12736.
- Сажин А.В., Кириенко А.И., Курцер М.А., Коноплянников А.Г., Панин А.В., Сон Д.А., Шуляк Г.Д. Острый аппендицит у беременных. Хирургия. Журнал им. Н.И. Пирогова. 2019;1: 70‑7. [Sazhin A.V., Kirienko A.I., Kurtser M.A., Konoplyannikov A.G., Panin A.V., Son D.A., Shuljak G.D. Acute appendicitis during pregnancy. Pirogov Russian Journal of Surgery. 2019; (1): 70‑7. (in Russian)]. https://dx.doi.org/10.17116/hirurgia201901170.
Received 16.05.2024
Accepted 17.06.2024
About the Authors
Vladimir Ye. Milyukov, Dr. Med. Sci., Professor, Head of the Academician Yu.M. Lopukhin Department of Topographic Anatomy and Operative Surgery of the Instituteof Anatomy and Morphology, Pirogov Russian National Research Medical University, Ministry of Health of Russia, 117997, Russia, Moscow, Ostrovityanov str., 1,
+7(916)156-41-27, Milyucov@mail.ru, https://orcid.org/0000-0002-8552-6727
Nikolay O. Bartosh, Dr. Med. Sci., Correspondent Member of the Russian Academy of Education, Professor at the Academician Yu.M. Lopukhin Department of Topographic Anatomy and Operative Surgery of the Institute of Anatomy and Morphology, Pirogov Russian National Research Medical University, Ministry of Health of Russia,
117997, Russia, Moscow, Ostrovityanov str., 1, +7(903)721-59-20, no.bartosh@gmail.com, https://orcid.org/0009-0004-9284-0732
Elizaveta A. Brileva, student of the N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia
(Sechenov University), 119991, Russia, Moscow, Trubetskaya str., 8-2, +7(916)491-04-80, lbrileva@yandex.ru, https://orcid.org/0000-0001-8445-3688
Diana R. Zakirova, student of the N.V. Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia
(Sechenov University), 119991, Russia, Moscow, Trubetskaya str., 8-2, +7(963)528-18-34, Dr.Zak.rova@yandex.ru, https://orcid.org/0000-0001-8445-3688
Corresponding author: Elizaveta A. Brileva, lbrileva@yandex.ru
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