Empyema and lung abscess as complication of a perforated appendicitis in a pregnant woman.

INTRODUCTION: The development of empyema as a result of an intra-abdominal pathology is a rare condition. PRESENTATION OF CASE: We present a 31-year-old woman at 28 weeks' gestation who was referred to our hospital with diagnosis of pneumonia with pleural effusion. She presented with signs of septicemia and fetal distress. A thoracic-abdominal-pelvic CT-scan showed a right pleural effusion with a retroperitoneal collection in contact with the pleural space. Due to her critical condition, immediate surgical exploration and pregnancy interruption was decided. The fetus was delivered by cesarean with satisfactory vitality. After abdominal exploration, a retrocecal appendicular abscess was evidenced and appendectomy was performed. Subsequently, the right chest was accessed through a posterolateral thoracotomy. An empyema with lung abscess and purulent fluid accessing from the retroperitoneum at the posterior pleural space was found. Due to parenchymal compromise, a right inferior lobectomy was performed. The patient had an uneventful recovery and was discharged at postoperative day 10. DISCUSSION: A septic condition in a pregnant patient with significant thoraco-abdominal infection requires an aggressive approach, with interruption of pregnancy and urgent exploration of the chest and abdomen.
CONCLUSION: When an empyema is developed in absence of lung disease or other intrathoracic cause, intra-abdominal origin should be considered.