Acute Appendicitis in Pregnancy

Even More Tummy Pain

Step 1: View clinicals

A 27 year old primipara in her 30th week of pregnancy presents with pain in the lower abdomen for 1 day, in association with anorexia and nausea. There was no history of fever, vomiting, urinary symptoms or bowel symptoms. Her pregnancy has been unremarkable so far, while her medical and surgical histories are unremarkable. She is not on any drugs. Her full blood count is significant for a leukocyte count of 13,500/mm3, with 70% neutrophils. A urinalysis is within normal parameters.


Step 2: Order all relevant investigations

Ultrasound Abdomen

A single live intrauterine pregnancy compatible with 30 weeks of gestation is seen. The appendix cannot be visualized. The liver, gallbladder, kidneys, and ovaries appear normal.

MRI Abdomen & Pelvis

The MRI scan reveals the presence of an enlarged appendix measuring 8mm in diameter, with peri-appendiceal inflammation.

Diagnostic Laparoscopy

You realize that this might be a bad idea.

GC + CT NAAT

You realize that Nucleic Acid Amplification Testing (NAAT) for Chlamydia and Gonorrhea is probably not indicated here.


Step 3: Select appropriate management

Perioperative Antibiotics
Cesarean section
Appendectomy
Tocolytics


Score: ★★☆