A Case of Post-Partum Afebrile Perforated Appendicitis: A Diagnostic Dilemma

There are a couple of references in literature reporting the incidence of acute appendicitis during pregnancy, and the incidence rate is 0.4-1.4 per 1000 pregnancies. Acute appendicitis and perforated acute appendicitis in the postpartum period are rare incidences. Fever and abdominal pain are very common symptoms in acute appendicitis. Here, we are presenting a case of postpartum acute perforated appendicitis. A 34-year-old female was admitted in the department of obstetrics and gynecology with abdominal pain and severe abdominal tenderness. The cervical os was dilated, so the patient was taken to the labor room where she delivered a very low birth weight baby at 22 weeks. After delivery, patient developed respiratory distress and there was a sudden deterioration in her condition. She was then shifted to the critical care unit. The case was managed and the patient's respiratory distress lessened but the abdominal pain and tenderness still persisted. Plain radiography was done and it showed "gas under diaphragm." The CT scan also showed pneumoperitoneum and a decision was taken to perform an emergency laparotomy. On laparotomy, perforated appendicitis was found. Diagnosis of acute abdomen in pregnancy and the early postpartum period is very confusing, but an early diagnosis is always important. In antenatal screening, an ultrasound of the whole abdomen should be mandated in 30+ years old pregnant women. Surgery is the recommended treatment in such cases.