By A. Lander
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Additional resources for Appendicitis - A Coll. of Essays From Around the World
The patient underwent a laparotomy and right hemicolectomy. The appendix was found to be perforated and abscess formation was also noted and drained at surgery. While inflamed appendices within a hernia is rare, it should be noted that the perforation of the appendix into a limited space prevents the spillage of enteric contents into the abdominal cavity. In this case the perforated appendix was contained within the femoral hernia and so rather than developing diffuse peritonitis, the patient developed superficial signs of erythema, tenderness and induration.
White cell counts can be misleading as they are raised as a consequence of the pregnancy. A delay in the diagnosis of acute appendicitis can put the fetus at risk and a ruptured appendicitis is associated with a fetal loss rate of between 20% and 25% (Kilpatrick et al, 2007). It is therefore essential to confirm the diagnosis by ultrasonography. This avoids ionising radiation but can be difficult due to the displaced anatomy. Not visualising the appendix does not rule appendicitis out and therefore the diagnosis would still be in question.
New England Journal of Medicine, 338:141-6 Rao PM, Rhea JT, Rao JA et al (1999). Plain abdominal radiography in clinically suspected appendicitis: diagnostic yield, resource use and comparison with CT. American Journal of Emergency Medicine, 17:325-328 Raynor MR, Cliff AD, Ord JK (2010). Common acute childhood infections and appendicitis: a historical study of statistical association in 27 English public boarding schools, 1930-1934. Epidemiology and Infection, 138(8):1155-65 Rothrock SG, Skeoch G, Rush JJ et al (1991).
Appendicitis - A Coll. of Essays From Around the World by A. Lander