Acute appendicitis, appendectomy and female fertility: an assessment of the problem

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Resumo

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.

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Sobre autores

Vladimir Milyukov

N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia

Email: Milyucov@mail.ru
ORCID ID: 0000-0002-8552-6727

Dr. Med. Sci., Professor, Head of the Academician Yu.M. Lopukhin Department of Topographic Anatomy and Operative Surgery of the Institute of Anatomy and Morphology

Rússia, Moscow

Nikolay Bartosh

N.I. Pirogov Russian National Research Medical University, Ministry of Health of Russia

Email: no.bartosh@gmail.com
ORCID ID: 0009-0004-9284-0732

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

Rússia, Moscow

Elizaveta Brileva

I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)

Autor responsável pela correspondência
Email: lbrileva@yandex.ru

student of the N.V. Sklifosovsky Institute of Clinical Medicine

Rússia, Moscow

Diana Zakirova

I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia (Sechenov University)

Email: Dr.Zak.rova@yandex.ru

student of the N.V. Sklifosovsky Institute of Clinical Medicine

Rússia, Moscow

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