Spontaneous Hemoperitoneum in Pregnancy: Masquerading as Acute Appendicitis
Johnbosco Mamah1, Megan Thomas1, Junaid Rafi1
1Obstetrics and Gynaecology, East Suffolk and North Essex National Health Service (NHS) Foundation Trust, Ipswich, GBR.
Cureus
|November 29, 2023
Summary
Spontaneous hemoperitoneum in pregnancy (SHiP) is a rare obstetric emergency. This case highlights a unique SHiP presentation initially misdiagnosed as appendicitis, emphasizing the need for prompt diagnosis and management in pregnant patients.
Area of Science:
- Obstetrics and Gynecology
- Surgical Case Reports
- Maternal-Fetal Medicine
Background:
- Spontaneous hemoperitoneum in pregnancy (SHiP) is a rare but potentially life-threatening obstetric emergency.
- Endometriosis is a known risk factor for various gynecological and obstetric complications.
- Accurate and timely diagnosis is crucial for optimal maternal and fetal outcomes in SHiP.
Observation:
- A primigravid woman at 32+5 weeks gestation presented with abdominal pain, initially diagnosed as acute appendicitis.
- The patient experienced rapid clinical deterioration, including shock and fetal distress, necessitating emergency surgical intervention.
- Severe endometriosis was noted as a pre-existing condition in the patient.
Findings:
- Emergency laparotomy revealed uncontrollable bleeding, leading to hysterectomy and left salpingo-oophorectomy.
- Despite the severity of the maternal condition, the baby was delivered in good health.
- The mother recovered uneventfully following the surgical procedures.
Implications:
- This case underscores the importance of considering SHiP in the differential diagnosis of abdominal pain during pregnancy, even with atypical presentations.
- Early recognition and multidisciplinary management are vital for improving outcomes in SHiP.
- Understanding the potential link between endometriosis and SHiP may aid in risk assessment and prevention strategies.
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