腹腔镜阑尾切除术继发发热急性穿孔阑尾炎模仿早期妊娠先兆流产在坦桑尼亚：一个病例报告。

IF 0.6 Q4 SURGERY

International Journal of Surgery Case Reports Pub Date : 2025-02-01 DOI:10.1016/j.ijscr.2025.110879

Harold L. Mashauri , Kasimu B. Ndyamukama , Alfred G. Nyamwihula , Anthony M. Mapande

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引用次数: 0

摘要

妊娠阑尾炎是最常见的非产科外科疾病，需要紧急评估和立即采取多学科干预措施。妊娠解剖和生理变化可以掩盖阑尾炎的表现，并提出诊断和管理的挑战。病例介绍：一名32岁女性，G3P2L2，孕龄11周，经超声检查，表现为反复发作的急性腹痛，持续一天，发热，但伴有食欲不振，恶心和呕吐，以及三天前开始的阴道点滴。她最初被诊断和治疗为先兆流产病例，症状没有改善。镇痛药对腹痛难治。腹部盆腔超声检查两次，未发现阑尾炎的特征，而产科超声检查无明显差异。临床检查显示Alvarado评分为7分。诊断性腹腔镜检查证实急性阑尾炎穿孔，她接受腹腔镜阑尾切除术，术后恢复顺利。讨论：急性阑尾炎是具有挑战性的诊断和处理在怀孕期间，由于症状重叠与产妇的生理和解剖变化以及产科表现，如先兆流产。像Alvarado评分这样的阑尾炎评分系统即使在怀孕期间仍然是可靠的诊断工具，而像USS这样的首选成像的使用在妊娠子宫后更为有限。结论：所有有急性腹痛和疑似急性阑尾炎特征的孕妇都应进行彻底的筛查。诊断腹腔镜在妊娠诊断和治疗中是有用的和友好的。多学科方法在评估和管理这种情况下，在妊娠是高临床效益的母胎结局。

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

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.

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