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Intra-abdominal bleeding in appendicitis
1Department of Surgery, Samut Prakan Hospital, Thailand.
Summary
A pregnant woman presented with severe abdominal pain and fainting due to internal bleeding. Emergency surgery revealed a ruptured appendicitis causing a torn appendicular artery, leading to massive hemorrhage.
Area of Science:
- Obstetrics and Gynecology
- Gastroenterology
- Surgical Pathology
Background:
- Ectopic pregnancy is a life-threatening condition in early gestation.
- Abdominal pain and hemodynamic instability are critical signs requiring urgent evaluation.
- Ruptured appendicitis can present atypically, especially in pregnant patients.
Observation:
- A 34-year-old woman, 10 weeks pregnant, presented with syncope and abdominal pain.
- Physical exam revealed hypotension, pallor, abdominal tenderness, and guarding.
- Culdocentesis confirmed hemoperitoneum.
Findings:
- Laparotomy identified 2,500 ml of hemoperitoneum.
- Active arterial bleeding originated from a torn appendicular artery.
- The appendicular artery tear was secondary to perforated appendicitis, caused by a fecalith.
Implications:
- This case highlights a rare but critical presentation of appendicitis mimicking ectopic pregnancy.
- Prompt surgical intervention (appendectomy) is crucial for patient survival.
- Accurate diagnosis and management are vital in obstetric emergencies with gastrointestinal origins.