Acute ruptured appendicitis in the second trimester of pregnancy

Abstract

Acute appendicitis is the most common non-obstetric indication for surgical intervention in pregnancy. Due to the anatomical and physiological changes associated with pregnancy, appendicitis may pose a diagnostic dilemma leading to management delays and increase in the risk of appendiceal perforation. The often non specific presentation in pregnancy may require utilization of diagnostic imaging to aid in accurate diagnosis. To report a case of typical presentation of acute appendicitis in a pregnant woman. The case note of the patient was retrieved and the management reviewed. Relevant review of the literature on the subject was also done. She was a 31 year old multipara with 2 previous caesarean sections who presented at the accident and emergency unit of Braithwaite Memorial Specialist Hospital at 20 weeks gestation with progressively increasing peri umbilical and right iliac fossa pain of 9 hours duration. There were nausea, vomiting and fever. There was marked tenderness with guarding at the region of right iliac fossa. She had emergency appendicectomy. Findings were purulent peritoneal fluid and ruptured oedematous appendix. She did well post operatively and was discharged home to continue with antenatal care. Subsequently antenatal care remained uneventful until she had a repeat caesarean section at term. Mother and baby were discharged in good clinical state. Changes that occur during pregnancy can delay the diagnosis of acute appendicitis threatening the lives of the mother and fetus. Therefore prompt diagnosis and treatment is important to prevent maternal and fetal morbidity and mortality.

Keywords: acute appendicitis, mid trimester, appendicectomy