Pregnant Mother With Perforated Appendix

When Madam A, a 24 year old lady from Indonesia, came to see me, she suffered from pain in the lower abdomen.

She had been having fever, pain and diarrhoea for the past 2 weeks. She was also 10 weeks pregnant.

I decided to quickly proceed with an ultrasound scan of her abdomen to find out the cause. The scan showed her 10 week old pregnancy with a large 14 cm abscess in the pelvis due to a perforated appendix.

Clearly, surgery was necessary.

But here’s the thing –  if she underwent an open surgery, she would have required laparotomy (long midline incision) which would have left her with a large lower abdominal wound.

This would then be a potentially weak area in her abdominal wall. As her pregnancy advanced, there would be a risk of developing a hernia or rupture of the laparotomy wound. Furthermore, a large abdominal wound would also make it more and more uncomfortable later in pregnancy.

She was quite worried. As all expecting mothers go, she was clearly worried about the risk of surgery to her unborn child.
I recommended that we try a laparoscopic approach first and if that did not work out as well as it should, we might have to go with an open procedure or open surgery.

While an operation sounds easy, it isn’t always the case. Every operation is a challenge on its own.

And this was one of my most difficult laparoscopic appendicectomies.

The womb was much larger than normal and was sitting just next to the abscess. It had to be handled with extreme care, if at all.

We discovered a large abscess full of pus in the pelvis in front of the uterus. The appendix had ruptured and disintegrated. After a lengthy and careful dissection, we found and removed the remnants of the shattered appendix and drained the abscess cavity of pus.

Madam A made a slow but steady recovery after the surgery. She went home to Indonesia when she was well enough to travel.

She happily reported that her pregnancy proceeded without further complication and she gave birth to a healthy baby 6 months later.