Appendicitis in Pregnancy

Patient Presentation:
A 22-year-old female presents from the ER complaining of constant RLQ pain for the last two days that is increasing in severity. The pt is 26 weeks pregnant. Pt denies urinary urgency, frequency or pain with urination. Pt BP is 110/90 and pt denies visual changes, epi-gastric pain, any pain in the right or left upper quadrants and denies pain that wraps to the shoulders or back. Patellar reflexes are +2 and no clonus. Pt denies leaking of fluid from the vagina and bleeding from the vagina. The pt's abdomen is tender to palpation all over. Pt is placed on her left side and the abdomen is palpated, pt reports an increase in pain during this palpation. The pt rates her pain on a scale of 1-10 as a 7 and describes it as “constant and sharp”. Pt is placed on the fetal monitor and the fetal heart rate is normal for gestation, no contractions are noted.

Differential Diagnosis:
Uterine rupture, Placental Abruption, HELLP, Pre-eclampsia, Cholestasis, UTI/pyelonephritis, Appendicitis.

Diagnosis:
CBC with diff was drawn it showed an elevated WBC 24,000 with elevated segs.
Pts temperature was 101.
BMP, Uric acid and LDH were all normal.
U/A showed mild dehydration but no bacteria.
Ultrasound revealed an intact placenta, intact uterus, no gallstones or kidney stones but the appendix was noted to be inflamed.

Treatment:
Pt was advised by her OB to have immediate surgery, the risks of pre-term labor were discussed with the patient. The patient consented to laparoscopic surgery to remove the appendix.

Outcome:
The patient did not go into pre-term labor and the laparoscopic surgery successfully removed her appendix.

Case created by Erin-Ellen Dillon, 2011.