Complicated Appendicitis in Pregnancy Masquerading as Septic Abortion: A Case Report

The early diagnosis of complicated appendicitis in pregnancy remains challenging. We report the case of a 25-year-old multiparous woman with complicated appendicitis masquerading as septic abortion in the first trimester. She was referred to us on the second post-abortal day with persistent abdominal pain. Two days earlier, at 12 weeks of gestation, she had presented to her local hospital with lower abdominal pain and vaginal bleeding. She was diagnosed with inevitable abortion, and a suction and evacuation procedure was performed. On presentation to our center, she was septicemic with features of systemic inflammatory response syndrome. She was febrile, with a blood pressure of 100/70 mm Hg, a total leukocyte count of 14,210/cumm, and 79.1% neutrophils. Ultrasound revealed a bulky uterus with an intact contour and a septated pelvic collection. A provisional diagnosis of septic abortion was made, and she was started on broad-spectrum antibiotics. After 24 hours, her condition showed no improvement. Contrast-enhanced CT revealed multiple fluid collections. An emergency laparotomy, following a failed laparoscopic attempt, demonstrated a perforation at the base of the appendix along with a fecalith in the peritoneal cavity. She was discharged on postoperative day 7 and was doing well at follow-up. Histopathology confirmed appendicular perforation, which probably caused the first-trimester abortion. A high index of suspicion, combined with imaging modalities such as ultrasonography and/or MRI/CT, is essential for the early diagnosis of complicated appendicitis in pregnancy. Early surgical intervention in cases of appendicular perforation complicating pregnancy is crucial to achieve optimal outcomes.