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