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.
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