The consequences of missing appendicitis during pregnancy.

A 23-year-old second para was admitted for severe anaemia with abdominal distension in the immediate puerperal period following a preterm delivery. She suffered from acute abdominal pain 3 days back (at 32 weeks of gestation) and was evaluated in the emergency medical department for appendicitis/cholecystitis. Abdominal ultrasound was found to be normal and she received antacids for her pain abdomen. Clinical examination the day after delivery revealed abdominal distension, guarding and rigidity. Ultrasonography revealed a normal puerperal uterus with free fluid in the abdomen which on diagnostic aspiration was pus. Emergency laparotomy showed acute suppurative appendicitis with perforation. Appendecectomy with peritoneal lavage was done. Her postoperative period was stormy with high febrile spikes and evaluation confirmed septicaemia. The organism grown on postoperative blood culture and cervical swab culture was Enterococcus fecalis sensitive to vancomycin and she received the same for 10 days and recovered.