Two Cases of Acute Appendicitis in Pregnancy with Difficulty of Diagnosis and Treatment

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  • 診断，治療に難渋した妊娠期急性虫垂炎の２手術例

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We report herein on two cases of acute appendicitis in pregnancy in which both the diagnosis and treatment presented difficulties. Case 1 : A 37-year-old woman at 22 weeks gestation was admitted to our hospital for lower abdominal pain. The patient's WBC was 15,300/mm3 and CRP was 12.6mg/dL. The appendix was not detected on ultrasonography. However probe laparotomy was performed because of uterine contraction uncontrollable by medication. Subsequently, a ruptured appendix was found in the Douglas cavity and an appendectomy was performed. The patient continued the pregnancy and delivered a full term infant. Case 2 : A 29-year-old woman at 32 weeks gestation was admitted to our hospital with a high fever. The patient's WBC was 9,400/mm3 and CRP was 9.2mg/dL. The appendix was not revealed on magnetic resonance imaging. However the patient's abdominal pain was so severe that probe laparotomy was carried out. An abscess due to perforating appendicitis was found in the retroperitoneum and we performed an appendectomy after a cesarean section. Postoperatively the patient developed bowel obstruction and was treated conservatively until being discharged on the 22nd postoperative day. Decision-making regarding the surgical timing of acute appendicitis in pregnancy is difficult. Therefore, surgeons should cooperate with the obstetrician from the stage of the provisional diagnosis.

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