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CASE REPORT
Should the laparoscopic approach be the norm for appendicectomy in the third trimester of pregnancy?
  1. Hashviniya Sekar1,
  2. Nisha Rajesh Thamaran2,
  3. David Stoker2,
  4. Sayantana Das3 and
  5. Wai Yoong4
  1. 1 Obstetrics and Gynaecology, Royal Free London NHS Foundation Trust, London, UK
  2. 2 General Surgery, North Middlesex University Hospital NHS Trust, London, UK
  3. 3 Obstetrics and Gynaecology, Royal London Hospital, London, UK
  4. 4 Obstetrics and Gynaecology, North Middlesex University Hospital NHS Trust, London, UK
  1. Correspondence to Dr Hashviniya Sekar, hashviniya.sekar{at}nhs.net

Abstract

Our case describes a pregnant woman with acute appendicitis who presented in the third trimester and underwent a laparoscopic appendicectomy. She made a rapid postoperative recovery and the pregnancy was otherwise uncomplicated, ending with a spontaneous vaginal birth at 41 weeks. The diagnosis of acute appendicitis can be unclear in pregnancy. Difficulty in establishing diagnosis due to atypical presentation often leads to delay in surgery, resulting in significant maternal and fetal morbidity and mortality. Surgical intervention should be prompt in cases of suspected appendicitis and the laparoscopic approach is advocated in the first two trimesters. In the third trimester (after 28 weeks), laparotomy is often performed due to the size of the uterus and the theoretical risk of inadvertent perforation with trocar placement. More recently, several authors have described successful outcomes following laparoscopic appendicectomy after 28 weeks and with increasing reassuring data, we suggest that this minimally invasive approach should be considered in managing appendicitis in the third trimester.

  • obstetrics and gynaecology
  • pregnancy
  • general surgery
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Footnotes

  • Contributors There are five authors involved in the submission of this case report. HS: Responsible for acquisition of data, literature review, doing the first draft and editing it accordingly until all authors give approval. Editing images. Organising final submission. NRT: Responsible for acquisition of data, performing the operation, editing final manuscript. DS: Responsible for acquisition of data, performing the operation, editing final manuscript. Sayantana Das: Responsible for acquisition of data, obtaining written consent from patient, editing final manuscript. WY: Responsible for acquisition of data, literature review, editing final manuscript and providing overall supervision for submission of manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.

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