Appendicitis in gravida (MRI)

Case contributed by Dr Yair Glick

Presentation

Abdominal pain and vomiting in a woman 23 weeks into her second pregnancy - suspected appendicitis.

Patient Data

Age: 25 years
Gender: Female

Inflamed appendix with large, long appendicolith measuring 2.5 cm in length in its proximal part. The distal appendix measures 15 mm in diameter. Marked periappendiceal fat edema and stranding. The appendix is mediocecal and is located posterior to the uterus at the level of the umbilicus. No distension of small or large bowel loops.

Mild right hydronephrosis. Small cyst in the lower pole of the left kidney.

Study protocol not dedicated to obstetric imaging. Within said limitation: cephalic position; anterior placenta, does not border on cervix; no evidence of abruptio placentae. Ovaries of normal size, contain small peripheral follicles.

Small amount of free intraperitoneal fluid in the pelvis.

Periumbilical subcutaneous edema.

Thickened appendix (between red arrowheads) with large appendicolith (yellow arrow).

Case Discussion

The woman was rushed to the OR and a perforated phlegmonous appendix with a fecalith was laparoscopically removed. The area was washed and suctioned.

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