Case Report:
Case History/ Examination: A previously healthy 34 years old
female with no previous history of surgery, P1+0 had admitted at
department of obstetrics and gynaecology of Raiganj Govt Medical College
and Hospital with severe abdominal pain. Over abdominal examination,
patient had a severe abdominal tenderness and os was opened. The vitals
and the body temperature were in normal limit and no history of fever
was given. No history of recent vomiting was present. There was a
diagnostic dilemma, but as os was opened, so the patient was taken to
labour room. Her ante-partum period was uncomplicated without any
history of pre-eclampsia or pregnancy induced hypertension. She gave
birth of very low birth weight child through vaginally at 22 weeks. At
day 0, after the delivery, suddenly the condition of the mother had been
deteriorated and the patient was shifted to Critical Care Unit (CCU)
where she found to have hypokalaemia and shortness of breath. Eventually
the potassium level was corrected. Still the abdominal pain and
tenderness persisted.
Methodology: A straight X ray of the abdomen was suggested.
There “gas under diaphragm” was found. (Fig 1) Ultrasound report had
shown a 15*7.6 cm collection with inter echogenic foci at lower abdomen
and pelvis. CT report had shown pneumoperitoneum. (Fig2)
Conclusion and Result: Emergency laparotomy was done under
general anaesthesia. This was a case of appendicular perforation at the
base of the appendix with huge collection of pus (approximately 4
Litre). Appendectomy was done and the base of the caecum was repaired. A
drain was given which was removed at post operative day 6. So that, the
septic peritonitis had led to preterm labour and preterm birth.
Post Operative recovery was uneventful. Flatus was passed within 48
hours of the operation. Semisolid diet was given on post operative day
(POD) 3 and patient got discharged in POD 8. This case has been managed
with a collaborative approach of Department of Obstetrics and
Gynaecology and Department of Surgery of Raiganj Govt Medical College
and Hospital, India