A case report of acute apendicitis in puerperium

Česká verzia

Authors: M. Mojhová ¹ ; I. Mikysková ¹; O. Dubová ¹ ; E. Homolková ¹; M. Mašek ²; Michal Zikán ¹
Authors place of work: Gynekologicko-porodnická klinika Nemocnice Na Bulovce a 1. LF UK, Praha, přednosta prof. MUDr. M. Zikán, Ph. D. ¹; Radiodiagnostická klinika Nemocnice Na Bulovce a 1. LF UK, Praha, primář MUDr. M. Mašek ²
Published in the journal: Ceska Gynekol 2019; 84(5): 341-344
Category: Case Report

Summary

Objective: This article stresses an impact of appropriate management work up in the diagnosis of acute apendicitis in puerperium. Atypical clinical symptoms may cause doubts in diagnosis and may delay necessary surgical intervention.

Design: Case report.

Settings: Department of Gynecology and Obstetrics, 1st Faculty of Medicine, Charles University, and Hospital Na Bulovce, Prague.

Methods: We present a case report describing an atypical presentation of acute apendicitis in early puerperium. Due to atypical course of the disease and atypical imaging locality and morphology, there were doubts about the diagnosis of acute apendicitis, patient was treated conservativelly and the disease later resulted in extensive surgical intervention.

Conclusion: Acute appendicitis is the most common cause of non-urogenital morbidity in puerperium. Management of work up and timing of surgical intervention have key impact on maternal mortality and morbidity.

Keywords:

apendicitis – postpartal – non-urogenital morbidity – surgical intervention

Zdroje

1. Abbasi, N., Patenaude, V., Abenheim, HA. Management and outcomes of acute appendicitis in pregnancy-population; based study of over 7000 cases. BJOG, 2014, p. 1509–1514.

2. Andersen, B., Nielsen, TF. Appendicitis in pregnancy, diagnosis, management and complications. Acta Obstet Gynecol Scand, 1999, 78, p. 758–762.

3. Babler, EA. Perforative appendicitis complicating pregnancy with report of a successful case. JAMA, 1908, 51, p. 1310–1314.

4. Burlinson, CEG., Sirounis, D., Walley, KR., Chau, A. Sepsis in pregnancy and the puerperium. Int J Obstet Anesth, 2018, 36, p. 96–107.

5. Casey, BM., Cox, SM. Cholecystitis in pregnancy. Infect Dis Obstet Gynecol, 1996, 4(5), p. 303–309.

6. Divya, W., Seema, S., Nivedtia, S., et al. Appendicitis in postpartum period: a diagnostic challenge. JCDR, 2015, 9(10), p. QD10–QD11.

7. El Ghali, MA., Kaabia, O., Mefteh, ZB., et al. Acute appendicitis complicating pregnancy: a 33 case series, diagnosis and management, features, maternal and neonatal outcomes. Pan Afr Med J, 2018, 30, p. 212.

8. Elshazzly, M., Bashjawish, F., Shahid, MA., et al. A challenging case of retroperitoneal abscess in a post-partum Crohn‘s disease patient. Am J Case Rep, 2018, 19, p. 773–777.

9. Guterman, S., Mandelbrot, L., Keita, H., et al. Laparoscopy in the second and third trimesters of pregnancy for abdominal surgical emergencies. J Gynecol Obstet Hum Reprod, 2017, 46(5), p. 417–422.

10. Kazim, SF., Inam Pal, K. Appendicitis in pregnancy: experience of thirty eight patients diagnosed and managed at a tertiary care hospital in Karachi. Int J Surg, 2009, 7, p. 365–367.

11. Kuvačič, I., Škrablin, S., Župančic, B, et al. Appendicitis in the early puerperium: case report. Gynaecol Perinatol, 2003, 12(3), p. 130–132.

12. Leyendecker, JR., Gorengaut,V., Brown, JJ. MR imaging of maternal diseases of the abdomen and pelvis during pregnancy and the immediate postpartum period. 2004, 24(5), p. 301–1316.

13. Ľubušký, M., Ľubušká, L., Procházka, M. Komplikovaný průběh apendicitidy v graviditě. Gynekolog, 2004, 13(4), s. 164–165.

14. Maslovitz, S., Gutman, G., Lessing, J., et al. The significance of clinical signs and blood indices for the diagnosis of appendicitis during pregnancy. Gynecol Obstet Invest, 2003, 56, p. 188–191.

15. Miloudi, N. Acute appendicitis in pregnancy: specific features of diagnosis and treatment. J Visc Surg, 2012, 149, p. e275–e279.

16. Murariu, D., Tatsuno, B., Hirai, CA., et al.Case report and management of suspected acute appendicitis in pregnancy. Hawaii Med J, 2011, 70(2), p. 30–32.

17. Palses, T., Humes, D., Brooks, A. Acute appendicitis. In: Brooks, A., Cotton, BA., Tai, N., Mahoney, PF., eds. Emergency surgery. Oxford, UK: Wiley-Blackwell, 2010, p. 29–33.

18. Rafi, J., Haroona, K. Maternal morbidity and mortality associated with retroperitoneal haematomas in pregnancy. JRSM, 2018, 9(1), p. 1–9.

19. Sánchez, AW., García-Benítez, CQ., Torreblanca, CB. Case report. Post cesarean section laparoscopic cholecystectomy for hydrocholecystitis. Ginecol Obstet Mex, 2011, 79(4), p. 230–234.

20. Sultan, AA., West, J., Tata, LJ., et al. Risk of first venous thromboembolism in and around pregnancy: a population-based cohort study. Br J Haematol, 2012, 156, p. 366–373.

21. www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg37b/. Thrombosis and Embolism during Pregnancy and the Puerperium: Acute Management (Green-top Guideline No. 37b).

22. Williams, R., Shaw, J. Ultrasound scanning in the diagnosis of acute appendicitis in pregnancy. Emerg Med J, 2007, 24, p. 359–360.

23. Won, RP., Friedlander, S., Lee, SL. Management and outcomes of appendectomy during pregnancy. Am Surg, 2017, 83(10), p. 1103–1107.