American Journal of Medical Case Reports
ISSN (Print): 2374-2151 ISSN (Online): 2374-216X Website: http://www.sciepub.com/journal/ajmcr Editor-in-chief: Samy, I. McFarlane
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American Journal of Medical Case Reports. 2019, 7(5), 87-89
DOI: 10.12691/ajmcr-7-5-3
Open AccessCase Report

Management of a Walled-off Perforated Appendix in a 39th Week Gestational Pregnancy: A Case Report

Aazim Arif1, , Cilia Nazef1, Karolain Garcia1, Aman Kataria2, Alexander Baradei3 and Kristy Crawford D.O.4, 5

1Florida State University College of Medicine, Fort Pierce Campus, Fort Pierce, FL

2Florida State University College of Medicine, Orlando Campus, Orlando, FL

3Florida State University College of Medicine, Sarasota Campus, Sarasota, FL

4Clinical Assistant and Professor at Florida State University College of Medicine, Fort Pierce Campus, FL

5Department of Obstetrics and Gynecology, Indian River Medical Center, Vero Beach, FL

Pub. Date: May 17, 2019

Cite this paper:
Aazim Arif, Cilia Nazef, Karolain Garcia, Aman Kataria, Alexander Baradei and Kristy Crawford D.O.. Management of a Walled-off Perforated Appendix in a 39th Week Gestational Pregnancy: A Case Report. American Journal of Medical Case Reports. 2019; 7(5):87-89. doi: 10.12691/ajmcr-7-5-3

Abstract

Background: One of the most common surgical problems that requires emergent intervention during pregnancy is acute appendicitis [1]. The incidence of appendicitis during pregnancy is 1 in 766 births, with 16% of the diagnoses occurring within the third trimester [1,2]. Acute appendicitis, with subsequent wall-off perforation, can pose a great risk to both the mother and the fetus. Thus, it is extremely important to recognize and correctly diagnose acute appendicitis, in all trimesters of pregnancy. Case Presentation: This case report discusses a 30-year-old G1P0 with a gestation age of 39.6 who presented to the hospital with complaint of flank pain that waxed and waned. The medical team consisting of labor and delivery nurses, obgyn attending physician and a general surgery attending. Possible etiologies for such presentation including UTI, nephrolithiasis, pyelonephritis, uterine abruption, uterine rupture or musculoskeletal causes were all effectively ruled out. MRI was then performed and suggested appendicitis with associated appendicolith. The risk of perforation and potential complication was discussed amongst the patient, obstetrician and general surgeon. The patient was given an active participation in the decision making and ultimately decided that she would like to proceed with cesarean and appendectomy. Conclusions: Given the nonclassical presentation of acute appendicitis in pregnancy, a closer evaluation for the underlying etiology is warranted. Acute appendicitis in pregnancy should not be excluded based on clinical evaluation alone, as there is great risk posed to the mother and fetus if missed. Imaging should be performed if no other underlying etiology can account for the clinical features. Any diagnostic uncertainty may delay surgical intervention resulting in risk of maternal morbidity and potential fetal mortality. In term patients, expeditious delivery followed by appendectomy may be warranted.

Keywords:
pregnancy acute appendicitis management

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