Appendicitis in pregnancy: a rare presentation

Appendicitis is difficult to diagnose in pregnancy. The incidence of appendicitis in pregnancy (G.05%-0.07%)1 is similar to that in the general population, but pregnant patients are more likely to present with perforations (43% v. 4%-19% in the general population).2,3 Perforations in pregnancy often lead to serious complications, including intraperitoneal infections and fetal death. The risk of perforation appears to increase with gestational age,4 and perforation in the third trimester often results in the onset of preterm labour.4 Pregnancy is associated with anatomic and physiologic changes that may disguise and delay the diagnosis of acute appendicitis. These include the cephalad displacement of the appendix from the right lower quadrant by the enlarged uterus,5 the increased leukocyte count in pregnancy and the physiologic increase in maternal blood volume that diminishes the woman's ability to demonstrate tachycardia or hypotension. A review of 22 cases of pregnant patients with appendicitis4 revealed that, although such women typically have abdominal pain, the typical presentation of appendicitis (abdominal pain, nausea and vomiting, fever and an increased leukocyte count) are unreliable in the pregnant patient.