28 year old female who presented to her OB with severe lower abdominal pain, nausea and inability to eat for at least 3 days.
Patient thought this was due to her pregnancy. She was pregnant with her first baby at 32 weeks. She has had a normal pregnancy up until these symptoms.
The OB admitted the patient to the hospital and blood work was undertaken. Her white blood cell count was elevated. She underwent an MRI (which is safer than CT in pregnancy). The MRI showed a collection of fluid around her appendix and an enlarged and inflamed appendix. It also confirmed an intrauterine 32 week pregnancy. She was started on IV ABX. An ATX robotic surgeon was consulted and the patient was diagnosed with ruptured appendicitis with likely abscess around the appendix.
Given the findings the patient was taken to the operating room on an emergent basis due to the risk it poses to losing the pregnancy. This video highlights the use of robotic surgery in emergent operations. With a very large uterus laparoscopic surgery becomes very difficult. The robotic technique allows us to use the 4KHD view to fully zoom in under the uterus and work in a very small space.
A large abscess can be seen which is drained.The appendectomy is completed without incident. The patient stayed in the hospital for 2 days to complete IV ABX. The fetus was monitored and showed no abnormalities. The patient returned to clinic and made a full recovery. She delivered a normal healthy male baby at term (week 40).