Conservative treatment of acute appendicitis in twin-pregnancy: a case report

Introduction Appendicitis is a rare but potentially life-threatening complication in pregnancy with an incidence between 0.04 % and 0.2 %. It is the most common cause of surgical interventions during pregnancy. Due to the anatomical changes the typical signs may be obscured and the diagnosis might be challenging. Incorrect and delayed diagnoses increase the risk of spontaneous abortions and premature deliveries.

Case We report a case of a 29-year-old woman with a twin-pregnancy at 27 weeks` gestation presenting with premature contractions and severe right flank pain, diagnosed in ultrasound a covered perforated appendicitis. With antibiotic therapy with co-amoxicilline the patient was asymptomatic and the infection parameters decreased to a normal level. A secondary cesarean section was performed at 33 weeks` gestation due to premature rupture of membranes and contractions. The appendectomy is planned after the breastfeeding period.

Conclusion The choice of conservative versus surgical treatment in acute appendicitis in pregancy is still debated. After clinical suspicion an ultrasound examination is mandatory. If the ultrasound is not conclusive a MRI should be performed. If there is no suspicion of a perforated appendix with peritonitis or a maternal sepsis, a conservative management including broad-spectrum antibiotics can be applied for 48 hours. If there is no improvement after 24-48 hours, an appendectomy should be carried out. However, in any case of acute appendicitis in pregnant woman a multidisciplinary team approach is recommended.

Publication History

Article published online:
07 October 2020