INCIDENTAL HEMATOPERITONEUM IN LAPAROSCOPIC APPENDECTOMY IN PREGNANT PATIENT
Journal
Македонски медицински преглед = Macedonian medical review
Date Issued
2025-04
Author(s)
Shurlani, Arben
Ismaili, Bashkim
Abstract
Acute appendicitis is the most common non obstetric emergency in pregnant women and often
associated with a late diagnosis and complications such as perforation and fetal loss. We present
a case of a 25-year-old primigravida, with epigastric pain radiating to the lower right quadrant
that appeared 12 hours before admission, nausea, vomiting, white tongue and foetor ex ore. The
laboratory values: WBC 18.000, RBC 4.12, HCT 36.2, CRP 22. Ultrasound examination: fetal
biometry corresponded to 7 gestational weeks, positive cardiac activity, a small amount of
peritoneal fluid was present in the right paracolic, ileocecal region and in Douglas's space,
thickening of the wall of appendix vermiformis, surrounding inflammation of fatty tissue. The
patient was observed in the next 6 hours, pain persisted in the lower right quadrant with
propagation to the left quadrant. An indication for laparoscopic intervention for acute
appendicitis has been made. The patient was placed in the supine position with the first camera
and extraction port supraumbilically (10 mm) and the second port (5 mm) suprapubically. On
laparoscopic exploration, 200 ml of bloody content was found in the pelvis and the vermiform
appendix with reactive changes in the middle part towards the apex. An infundibular paraovarian
cyst with a diameter of 20 mm was present on the right fallopian tube. The right ovary was
ruptured with bleeding on one side. A third port (5 mm) was placed left pararectally. Aspirated
pelvic blood was sent in the laboratory for beta HCG determination and partial resection of the
right ovary and appendectomy were performed. After lavage, a Redon drain was placed in the
pelvis through the suprapubic port. Postoperative course was normal and the drain was removed
on the second postoperative day. Gynecological ultrasound was performed on the third
postoperative day, the findings were normal and patient was discharged home.
associated with a late diagnosis and complications such as perforation and fetal loss. We present
a case of a 25-year-old primigravida, with epigastric pain radiating to the lower right quadrant
that appeared 12 hours before admission, nausea, vomiting, white tongue and foetor ex ore. The
laboratory values: WBC 18.000, RBC 4.12, HCT 36.2, CRP 22. Ultrasound examination: fetal
biometry corresponded to 7 gestational weeks, positive cardiac activity, a small amount of
peritoneal fluid was present in the right paracolic, ileocecal region and in Douglas's space,
thickening of the wall of appendix vermiformis, surrounding inflammation of fatty tissue. The
patient was observed in the next 6 hours, pain persisted in the lower right quadrant with
propagation to the left quadrant. An indication for laparoscopic intervention for acute
appendicitis has been made. The patient was placed in the supine position with the first camera
and extraction port supraumbilically (10 mm) and the second port (5 mm) suprapubically. On
laparoscopic exploration, 200 ml of bloody content was found in the pelvis and the vermiform
appendix with reactive changes in the middle part towards the apex. An infundibular paraovarian
cyst with a diameter of 20 mm was present on the right fallopian tube. The right ovary was
ruptured with bleeding on one side. A third port (5 mm) was placed left pararectally. Aspirated
pelvic blood was sent in the laboratory for beta HCG determination and partial resection of the
right ovary and appendectomy were performed. After lavage, a Redon drain was placed in the
pelvis through the suprapubic port. Postoperative course was normal and the drain was removed
on the second postoperative day. Gynecological ultrasound was performed on the third
postoperative day, the findings were normal and patient was discharged home.
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