Post Operative Miscarriage Following Ruptured Appendix in Pregnancy

Abstract

Acute appendicitis in pregnancy though rare, is the most common non- obstetric complication warranting emergency laparotomy. Gestational physiological changes make difficult the diagnosis and delay in diagnosis  and surgery results in increased complications. We present a-24 year old primiparous lady at 16 weeks of gestation who was referred from a private hospital to the accident and emergency unit of the University of Port Harcourt Teaching Hospital with 6 days history of abdominal pain, fever and vomiting at an ultrasound gestational age of 16 weeks and managed as case of ruptured appendix in pregnancy. She had laparotomy and appendicectomy. Intraoperative findings were purulent peritoneal exudates, ruptured appendix with flakes of necrotic tissues and fecolith. She subsequently had post operative miscarriage 48hours after the surgery which was completed by manual vacuum aspiration. She did remarkably well and was discharged on the 7th post operative day. Delay in diagnosis of appendicitis in pregnancy and surgery correlates to a more advanced disease with an increased risk of appendiceal rupture, which may contribute to increased risk of further complications. Prompt surgical intervention should be performed when acute appendicitis is suspected during pregnancy.

Key words: Ruptured appendix, appendicectomy, pregnancy, miscarriage.