Asian Journal of Case Reports in Surgery

Aim: Appendicitis during pregnancy is an uncommon but potentially life-threatening condition for both the mother and fetus. Its clinical presentation is often atypical, making timely diagnosis particularly challenging. Accurate imaging and early intervention are crucial to avoid serious complications.

Presentation of Case: We report the case of a 20-year-old primigravida at 15 weeks and 5 days of gestation who presented with right iliac fossa pain, fever, and elevated inflammatory markers. Initial ultrasound revealed a right lateral and retro-uterine collection, but it was inconclusive in distinguishing between a tubal abscess and an appendiceal abscess. Given the diagnostic uncertainty, an MRI without gadolinium was performed. The MRI demonstrated an inflamed, distended appendiceal tip within the collection, confirming the diagnosis of an appendiceal abscess.

Discussion: This case highlights the diagnostic limitations of ultrasound in pregnancy and underscores the value of MRI as a safe and effective imaging modality when appendicitis is suspected. A prompt appendicectomy with abscess drainage was performed, resulting in a favorable maternal recovery and continued fetal viability.

Conclusion: A high index of suspicion, appropriate use of MRI, and early surgical management are essential for achieving optimal outcomes in pregnant patients with suspected appendicitis.