DOI: 10.36347/sjmcr.2022.v10i06.024

Pages: 590-593

Appendicular peritonitis and pregnancy is a rare and serious association. The clinical presentation is sometimes misleading because of the anatomical and physiological changes associated with pregnancy, often responsible for diagnostic hesitation and therapeutic delay that are detrimental to the mother and the unborn child. The maternal-fetal prognosis depends on the severity of the abdominal pathology. We report the case of two patients aged 25 and 34, all multiparous. Admitted to gyneco-obstetrical emergencies for abdominal pain, postprandial vomiting and occlusive syndrome all on an evolving pregnancy of 32 and 34 SA. Clinical examination found on palpation a generalized contracture in one case, defense of the right hypochondrium. Fetal heart sounds were positive. Abdominopelvic ultrasound revealed intraperitoneal effusion in both cases without associated obstetric lesion. The abdomino-pelvic scan done in emergency allowed an individualization of a stercorite at the level of the FID, without clear visualization of the appendix, an occlusion of the organic small intestine on double band associated with a colonic occlusion by external compression of the sigmoid and with note a gestational sac of 34 SA. All patients were operated on within 24 hours of admission. Laparotomy found in both cases a gangrenous and perforated appendix associated with an intraperitoneal effusion which was removed and then aspirated. Retrograde appendectomy, peritoneal cleansing plus drainage was performed in all cases. Tocolysis and antibiotic therapy were instituted. The postoperative follow-up was simple, one week after the intervention one to give birth and the other three weeks later all vaginally.