# Delayed Diagnosis of Acute Appendicitis in the Third Trimester of Pregnancy: Diagnostic Pitfalls, Multisurgical Management, and a Prolonged Postoperative Course—A Multidisciplinary Case Report

## TL;DR

This case report details the challenges of diagnosing and managing acute appendicitis in a pregnant woman, highlighting the importance of prompt action and multidisciplinary care.

## Contribution

The report adds to the limited literature on using VAC therapy for abdominal eventration during pregnancy.

## Key findings

- Delayed diagnosis of appendicitis in the third trimester led to severe maternal complications.
- VAC therapy was successfully used for wound management after abdominal eventration.
- A multidisciplinary approach ensured recovery for both mother and child despite significant risks.

## Abstract

Background/Objectives: Acute appendicitis is the most common non-obstetric surgical emergency during pregnancy. Diagnosing appendicitis in the third trimester remains especially challenging due to physiological changes that obscure clinical presentation and limit the utility of imaging modalities. These challenges can lead to diagnostic delays, increasing the risk of severe complications for both mother and fetus. Case presentation: We present a complex case of a 36-year-old pregnant woman at 29 + 4 weeks of gestation who developed acute appendicitis with an atypical clinical course. Her initial symptoms were nonspecific and misattributed to gastrointestinal discomfort related to pregnancy. Her condition progressively worsened, leading to an emergency laparoscopic appendectomy. Intraoperative findings confirmed a perforated, necrotic appendix. Postoperatively, she experienced multiple complications, including ileus, wound dehiscence, and complete eventration of the abdominal wall. These required two additional laparotomies and the application of vacuum-assisted closure (VAC) therapy for effective wound management. Despite the severity of maternal complications and the risk of preterm delivery, a multidisciplinary team provided coordinated care. The patient was delivered vaginally at 34 + 4 weeks using vacuum assistance. The neonate, who developed sepsis, was treated in the neonatal intensive care unit and discharged after 24 days. Both mother and child ultimately recovered. Conclusions: This case highlights the diagnostic complexity of appendicitis in late pregnancy and the potential for severe postoperative complications. Prompt surgical intervention, high clinical suspicion, and a multidisciplinary approach are crucial. Moreover, this report adds to the limited literature on the use of VAC therapy for abdominal eventration in pregnancy, demonstrating its feasibility and safety in selected cases.