Acute appendicitis in pregnancy
28 weeks pregnant. Right upper quadrant pain and fever. No abnormality detected on ultrasound.
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There is an inflammatory mass in the right side, lying inferior to the right kidney and posterior to the ascending colon, continuous with the caecal pole. A fluid-filled tubular structure is seen in the centre of this inflammatory mass. Gravid uterus.
The MRI findings are consistent with acute appendicitis with an inflammatory mass in the right side of the abdomen, and the findings were confirmed at surgery. Due to a change in the position of the appendix during pregnancy, localisation of pain varies. The position as seen here also made an ultrasound diagnosis difficult to make. MRI, where available, is recommended as the second line modality by the ACR Appropriateness Criteria 1,2.
Macroscopic: Appendix covered in fibrinopurulent exudate 60x14mm.
Microscopic: This appendix shows abundant transmural acute inflammation and extensive tissue necrosis. There is no evidence of dysplasia or malignancy.
Conclusion: Appendix - acute gangrenous appendicitis
- 1. Page I. Wang, Suzanne T. Chong, Ania Z. Kielar, Aine M. Kelly, Ursula D. Knoepp, Michael B. Mazza, Mitchell M. Goodsitt. Imaging of Pregnant and Lactating Patients: Part 2, Evidence-Based Review and Recommendations. (2012) American Journal of Roentgenology. 198 (4): 785-92. doi:10.2214/AJR.11.8223 - Pubmed
- 2. Smith MP, Katz DS, Lalani T, Carucci LR, Cash BD, Kim DH, Piorkowski RJ, Small WC, Spottswood SE, Tulchinsky M, Yaghmai V, Yee J, Rosen MP. ACR Appropriateness Criteria® Right Lower Quadrant Pain--Suspected Appendicitis. (2015) Ultrasound quarterly. 31 (2): 85-91. doi:10.1097/RUQ.0000000000000118 - Pubmed