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BMJ Case Rep. 2019 Apr 5;12(4). pii: e228192. doi: 10.1136/bcr-2018-228192.

Should the laparoscopic approach be the norm for appendicectomy in the third trimester of pregnancy?

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Obstetrics and Gynaecology, Royal Free London NHS Foundation Trust, London, UK.
General Surgery, North Middlesex University Hospital NHS Trust, London, UK.
Obstetrics and Gynaecology, Royal London Hospital, London, UK.
Obstetrics and Gynaecology, North Middlesex University Hospital NHS Trust, London, UK.


Our case describes a pregnant woman with acute appendicitis who presented in the third trimester and underwent a laparoscopic appendicectomy. She made a rapid postoperative recovery and the pregnancy was otherwise uncomplicated, ending with a spontaneous vaginal birth at 41 weeks. The diagnosis of acute appendicitis can be unclear in pregnancy. Difficulty in establishing diagnosis due to atypical presentation often leads to delay in surgery, resulting in significant maternal and fetal morbidity and mortality. Surgical intervention should be prompt in cases of suspected appendicitis and the laparoscopic approach is advocated in the first two trimesters. In the third trimester (after 28 weeks), laparotomy is often performed due to the size of the uterus and the theoretical risk of inadvertent perforation with trocar placement. More recently, several authors have described successful outcomes following laparoscopic appendicectomy after 28 weeks and with increasing reassuring data, we suggest that this minimally invasive approach should be considered in managing appendicitis in the third trimester.


general surgery; obstetrics and gynaecology; pregnancy

[Indexed for MEDLINE]

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