Introduction:
Bowel perforation needs an urgent clinical intervention and it
significantly increase the mortality in the patients. Bowel perforation
is rarely seen in post-partum mother. (1) Bowel perforation
after a normal vaginal delivery (NVD) is rarer than a Caesarean section
(C-section). (1)
Appendicitis can be operated during pregnancy but post-partum
appendicitis is very rare. (2) In perforated appendicitis,
“gas under diaphragm” in plain radiograph is also a very rare
incident. (3). Post partum perforated appendicitis is also
rarely reported. The most common differential diagnosis are peptic
perforation and bowel perforation. Other differential diagnosis are
Meckel’s diverticulitis, Ischemic colitis, bowel obstruction,
cholecystitis, Fitz Hugh Curtis syndrome, round ligament syndrome,
pelvis thrombophlebitis, torsion of adnexal structures etc.
From early 1900, surgeon’s are publishing papers related to appendicitis
during pregnancy, so currently surgeons are well aware of the diagnosis
and management of the appendicitis during pregnancy. Babler had
published a paper related to this in 1908. (4) Harris J
Timerman had published a paper in 1942, presenting two cases of
post-partum appendicitis. (5).
So, here we are presenting a very rare case of post-partum perforated
appendicitis, a diagnostic dilemma. The abdominal pain and tenderness
can be misinterpreted as labour pain and the septic peritonitis can lead
to a preterm labour and preterm delivery. (6)
Highlights:
- Post-partum Bowel perforation and Post Partum appendicitis are rare
- “Gas under diaphragm” due to perforate appendix is also rare
- Perforated Appendicitis in post-partum period is also rare