Discussion:
In 1932, Baer has shown the change in position of appendix during the
pregnancy. (7) The chance of infections and followed by
perforations can be increased due to this upward movement of appendix
during the pregnancy. In cases of appendicitis, fever is a key symptom
but in our case, fever was not there in the history of the patient.
An England based cohort study has mentioned, “pregnant women during the
antepartum period were 35% less likely to be diagnosed with acute
appendicitis than the time outside pregnancy, with the lowest risk
reported during the third trimester.” (8) The paper also
mentioned, “we found no increased risk of acute appendicitis in the
postpartum period compared with the time outside pregnancy among women
aged 15 and 34 years. However, the risk increased by almost 2-fold in
older women during the later postpartum. “ (8) So, it is
important to rule out appendicitis in the antepartum period and surgeons
should be very cautious with the older women because the chance of
appendicitis is increasing with age.
E Moltubak et al has shown an increase in appendicitis cases during the
peripartum and puerperium phases and there is a decrease in the
incidence in the third trimester. (9). There is a high chance,
in our case the perforation of the appendix has happened at
3rd Trimester and the septic peritonitis has induced
the labour.
Acute appendicitis during pregnancy has an incidence rate of 0.4 to 1.4
per 1000 pregnancies. (10). Hospital incidence rate of acute
appendicitis in pregnancy was 0.09%. (11) So, this needs an
urgent diagnosis and intervention. This can also lead to poor neonatal
outcome and high maternal mortality rate. Very few literature has
described appendicitis after delivery.
Incident of Appendicitis is rare during the post-partum period. An early
diagnosis is always important. In antenatal visit, ultrasound of whole
abdomen is also necessary along with FPP mode to rule out any abdominal
pathologies. Although, bowel perforation, bowel obstruction,
appendicitis are rare cases in pregnancy, but proper screening is
important mostly in older females (more than 30 years). Surgery is
always recommended as soon as the diagnosis has been made.
Figures: