Malvika Lakshmi
Acute appendicitis in the postpartum period is uncommon and may present atypically, often leading to diagnostic delay and increased morbidity. We present the case of a 32-year-old woman who developed perforated appendicitis with histologically confirmed appendiceal endometriosis three weeks following elective Caesarean section.
She initially presented with fever and progressively worsening right iliac fossa pain and was treated empirically for presumed gynaecological infection. Ongoing symptoms prompted re-presentation, where imaging with CT abdomen and pelvis demonstrated findings consistent with perforated appendicitis with an appendicolith and inflammatory mass. Despite initial conservative management with intravenous antibiotics, persistent sepsis necessitated surgical intervention. The patient underwent emergency laparoscopic limited right hemicolectomy with washout. Intraoperative findings revealed a dense inflammatory mass with multiple pus cavities and extraluminal faecoliths. Histopathological examination confirmed perforated appendicitis with multiple foci of endometriosis within the appendiceal wall. The postoperative course was complicated by superficial wound infection, managed conservatively.
This case highlights the diagnostic challenges of acute abdominal pathology in the postpartum period, where symptoms may be misattributed to obstetric or gynaecological causes. Appendiceal endometriosis is a rare entity and an infrequent finding in appendicectomy specimens, with an uncertain role in the pathogenesis of appendicitis. Its presence in this case likely represents coexistence rather than causation.
Early cross-sectional imaging, a high index of suspicion, and timely surgical intervention are essential to prevent complications and optimise outcomes in postpartum patients presenting with persistent abdominal pain.
Authors
Lakshmi Malvika Atluri, RCSeD, Edinburgh, United Kingdom
Kenneth Chongg, Royal Blackburn Hospital, Blackburn, United Kingdom
Azzam Al-Amin, Royal Blackburn Hospital, Blackburn, United Kingdom