In a pregnant patient presenting with abdominal pain and suspected appendicitis, an initial ultrasound should be performed to exclude obstetric causes for abdominal pain. MRI may be a reasonable next study if it is immediately accessible and radiologists with expertise in MRI interpretation are available. Otherwise, CT should be utilized.
In this systematic review and meta-analysis, no single aspect of the physical examination, imaging, or LRINEC score had high enough sensitivity to exclude necrotizing soft tissue infections. Contrast CT performed the best, but it was only 94.3% sensitive at best. If you have a high clinical suspicion, early surgical consultation is necessary for definitive diagnosis and management.
In opioid naïve patients 13-21 years of age, persistent opioid use was found in 4.8% of the post-surgical group vs 0.1% of those in the non-surgical group. Procedures associated with the highest risk of persistent opioid use were cholecystectomy and colectomy. Independent risk factors included older age, female sex, diagnoses of substance use disorder and chronic pain.