Differential diagnosis in pregnancy

The diagnosis of acute appendicitis in pregnancy can be confused by the irregular presentation of symptoms and signs. Nausea and vomiting may be attributed to 'morning sickness' and delay diagnosis.

The enlarging uterus displaces the appendix upwards and laterally and consequently, pain and guarding may be restricted to the upper abdomen. This may lead to a misdiagnosis of pyelitis or cholecystitis. The stretching of abdominal muscles in the late stages of pregnancy makes the detection of guarding and rigidity very difficult.

In the advanced stages of pregnancy, the differential diagnosis is one of pyelonephritis, cholecystitis, fibroid degeneration and concealed haemorrhage.