Acute appendicitis in pregnancy

Case contributed by Dr Vikas Shah

Presentation

28 weeks pregnant. Right upper quadrant pain and fever. No abnormality detected on ultrasound.

Patient Data

Age: 35 years
Gender: Female
MRI

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. 

Case Discussion

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.

Pathology

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

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Case information

rID: 59754
Published: 23rd Apr 2018
Last edited: 24th Apr 2018
Inclusion in quiz mode: Included

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