Diagnostic and management complexities of Acute Appendicitis during late pregnancy
Seema Ghani¹, Sabeena Allah din², Taha Hasan³
Northampton General Hospital¹, Isle of Wight NHS trust², Queen Elizabeth hospital Birmingham³
Objective
To report a case of acute appendicitis in a 36 week primiparous pregnant woman, emphasizing the diagnostic and management comple xities during
late pregnancy.
Case
Report
A
36 week primigravida presented in maternity triage with severe abdominal pain 10 10 unresponsive to paracetamol and dihydrocodeine, though Diamorphine provided partial relief The initial
assessment including observations, vaginal examination, and cardiotocography ( were normal, with no vaginal bleeding or uterine tenderness However, abdominal palpation revealed mild
tenderness and discomfort Differential diagnoses included placental abruption, Braxton Hicks contractions, and musculoskeletal pain The patient was admitted for observation
Reassessment
the following morning indicated a low likelihood of placental abruption, favouring musculoskeletal pain Blood tests (Hb 111 g/L, WCC 11 7 platelets 285 INR 1 1 were normal,
and CTG met Dawes Redman criteria An ultrasound excluded retroplacental clot The patient was discharged with dihydrocodeine and safety netting advice
She
returned after 1 day of discharge with persistent severe abdominal pain On assessment, her abdominal and speculum examination was unremarkable and CTG was normal Given localized
pain in the right iliac fossa ( appendicitis was suspected Surgical team reviewed the patient and advised for repeat of all blood tests, including liver function tests and amylase, and a CT scan
was requested Broad spectrum antibiotics were initiated, and the patient was kept "nil by mouth"mouth"( for potential surgery
A
multidisciplinary team ( discussion involving obstetric and surgical teams proposed combining a lower segment caesarean section ( with appendectomy if appendicitis was confirmed
The patient and her partner were informed of the need for surgery under general anaesthesia
The
CT scan confirmed appendicitis, and the patient underwent LSCS with appendectomy The procedure was challenging due to adhesion and limited access but successfully addressed the
infection The patient recovered well and was discharged with a 5 day antibiotic regimen
Discussion
Acute
abdominal pain in late pregnancy poses diagnostic challenges due to altered anatomy and overlapping symptoms Imaging, such as CT or MRI, aids in confirming conditions like appendicitis,
which is uncommo n but can lead to severe complications This case highlights the importance of timely, multidisciplinary management to prevent adverse maternal and fetal outcomes The
integrated approach of LSCS and appendectomy minimized risks and ensured a successful outcome
Conclusion
This
case emphasizes the need for vigilance and a multidisciplinary strategy in managing acute abdominal pain in
pregnancy, ensuring optimal outcomes for mother and baby
Contact information:
Seema
Ghani
Specialist
Registrar Northampton General Hospital NHS trust
eMail
: seemaghani @yahoo.com