Underlying Appendicitis Leading to Chorioamnionitis in Preterm Rupture of Membranes
Background: PPROM complicates 3% of pregnancies, the most commonly identified etiology is infection. Appendicitis is a well-known cause of peritonitis and systemic illness, complicating approximately 1/1700 pregnancies.
Case: A healthy 26 year old primagravida female at 24 weeks gestation presented with PPROM. She was managed expectantly and delivered at 26 weeks gestation due to suspected chorioamnionitis, manifested by abdominal pain and tenderness. Postpartum the patient complained of mild abdominal pain and nausea that was deemed appropriate for her post-operative state, and she was discharged home on post-operative day 3. The following day she presented to our emergency department with worsening abdominal pain. Imaging was suggestive of appendicitis, and the patient subsequently underwent surgery. Intra-operative findings were significant for an inflamed appendix matted to the posterior surface of the uterus and diffuse erythema of the uterine serosa. Final pathology reports confirmed acute appendicitis, chorioamnionitis and funisitis.
Conclusion: It is possible that an underlying appendicitis lead to intrauterine infection and subsequent preterm delivery in our patient.