Acute appendicitis in pregnancy

Case contributed by Dr Morouj Shaggah

Presentation

Acute lower abdominal pain and vomiting.

Patient Data

Age: 30 years.
Gender: Female

The appendix is seen in the right lower quadrant infero-posterior to the cecum reaching about 1.5 cm in maximum diameter at its tip, it appears fluid filled with thickened wall and  surrounded by fat stranding and minimal free fluid, suggesting acute appendicitis.

The visualized solid abdominal organs appear unremarkable.

Intrauterine gestation with gravid uterus.

The appendix appears dilated, fluid filled with diffuse wall thickneing, surrounded by echogenic fat and minimal free fluid.

Case Discussion

The imaging findings are consistent with uncomplicated acute appendicitis and was confirmed at surgery.

Ultrasound is the first-line modality due to its wide availability and ability to diagnose a range of abdominal diseases. However, due to the change in the position of the appendix caused by displacement by the gravid uterus, identification of the appendix may not be possible, and as such MRI has gained a growing role in this settting.

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