Fertility effects need not be considered in women with suspected appendicitis

In the management of patients with suspected appendicitis surgeons have been taught to operate early enough to prevent perforation at the cost of diagnostic accuracy. This has been especially important in women because of the fear of peritoneal adhesions after perforated appendix and subsequent tubular dysfunction and infertility. This attitude has led to an error rate of up to 50% in women of reproductive age. There is, however, no evidence that perforations can be prevented by such a policy, and perforated appendix has not been established as a cause of infertility in women. On p 963 Andersson et al report on a study of fertility patterns in 9840 Swedish women aged under 15 when they underwent appendicectomy and 47 590 age matched controls from the general population. They found no adverse effects on fertility in women with a history of perforated appendix. Explorations for suspected appendicitis in women in whom the appendix is not inflamed cannot therefore be justified on the grounds of prevention of infertility.

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Fertility patterns after appendicectomy: historical cohort study

Roland Andersson, Mats Lambe, and Reinhold Bergström
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