Laparostomy during pregnancy: A case report

Area of Science:

• Obstetrics and Gynecology
• Surgical Gastroenterology
• Critical Care Medicine

Background:

• Acute appendicitis is a common surgical emergency during pregnancy.
• Pregnancy-related physiological changes and concerns about radiation can delay diagnosis.
• Delayed diagnosis increases maternal and fetal morbidity and mortality.

Purpose of the Study:

• To present a case of perforated acute appendicitis in pregnancy.
• To highlight the challenges in diagnosing abdominal sepsis during pregnancy.
• To evaluate the effectiveness of a damage control approach using laparostomy.

Main Methods:

• Case report of a 38-year-old pregnant woman presenting with symptoms of acute appendicitis.
• Diagnosis of septic shock secondary to perforated appendicitis.
• Emergency exploratory laparotomy with appendectomy, abdominal lavage, and laparostomy.
• Intensive care unit management including vasopressors and dialysis.
• Delayed abdominal closure and continued obstetric follow-up.

Main Results:

• Generalized purulent peritonitis due to perforated appendicitis was identified.
• The patient developed septic shock requiring intensive care.
• Laparostomy facilitated damage control, preventing abdominal compartment syndrome.
• The pregnancy was maintained to term with an uncomplicated outcome.
• Incisional hernia was the sole observed morbidity.

Conclusions:

• Diagnostic delays in pregnancy-associated appendicitis can lead to severe abdominal sepsis.
• Laparostomy is a valuable damage control strategy in managing complex abdominal sepsis during pregnancy.
• This approach can lead to favorable outcomes, including the continuation of pregnancy.