Laparoscopic appendectomy secondary to afebrile acute perforated appendicitis mimicking threatened abortion in first trimester pregnancy in Tanzania: A case report

Abstract

Introduction

Appendicitis in pregnancy is the most common non-obstetric surgical condition which requires urgent evaluation and immediate intervention in a multidisciplinary approach. Pregnancy anatomical and physiological changes can mask the presentation of appendicitis and poses both diagnostic and management challenges.

Case presentation

A 32 year old female, G3P2L2 at gestation age of 11 weeks by USS, presented with recurrent episodes of acute abdominal pain for one day, afebrile but accompanied with poor appetite, nausea and vomiting along episodes of per vaginal spotting which started three days prior. She was initially diagnosed and treated as a threatened abortion case with no improvement of symptoms. Abdominal pain was refractory to analgesics. Abdominal pelvic USS was done twice and revealed no features of appendicitis while obstetric USS was unremarkable. Clinical examination revealed an Alvarado score of 7. A diagnostic laparoscopy confirmed acute perforated appendicitis and she underwent laparoscopic appendectomy with uneventful post-operative recovery.

Discussion

Acute appendicitis is challenging to diagnose and manage during pregnancy due to symptoms overlapping with maternal physiological and anatomical changes along with obstetric presentations like threatened abortion. Appendicitis scoring systems like the Alvarado score are still reliable diagnostic tools even during pregnancy while the use of preferred imaging like USS is more limited secondary to gravid uterus.

Conclusion

All pregnant women with acute abdomen pain and suspecting features of acute appendicitis should be screened thoroughly for the condition. Diagnostic laparoscopy is useful and friendly in diagnosis and management in pregnancy. Multidisciplinary approach in evaluating and managing such cases in pregnancy is of high clinical benefits for maternal-fetal outcomes.