Severe preeclampsia mimicking acute appendicitis

Preeclampsia has been frequently misdiagnosed as an entity unrelated to pregnancy, with resultant delay in appropriate management. In the case presented here, severe preeclampsia complicated by hemolysis, elevated liver enzymes, and low platelet count ("HELLP syndrome") in a 32-week twin gestation was misdiagnosed as acute appendicitis. Delay in diagnosis and an unnecessary appendectomy resulted in loss of one of the fetuses.