Case Report: ERAT-based management of appendiceal abscess in early pregnancy

Acute appendicitis during pregnancy, while rare with an incidence of approximately 0.063%, represents a clinically significant condition that necessitates careful management. Current treatment strategies for appendiceal abscess include antibiotic therapy, percutaneous catheter drainage (PCD), and surgical intervention. However, surgical approaches in pregnant patients are associated with considerable obstetric risks, including miscarriage, preterm labor, and fetal demise. Moreover, Non-operative management carries a reported failure rate of up to 30%. Endoscopic retrograde appendicitis therapy (ERAT) has emerged as an advanced endoscopic technique that may provide a viable therapeutic alternative for appendiceal abscess in pregnancy. We present the case of a 24-year-old female at 3 weeks and 4 days of gestation diagnosed with a appendiceal abscess, who exhibited a suboptimal response to initial combined therapy involving ultrasound-guided PCD and ertapenem. Following adjunctive ERAT, the patient demonstrated marked clinical and laboratory improvement, with resolution of symptoms and normalization of inflammatory markers, and was subsequently discharged without any adverse pregnancy outcomes. This case suggests that ERAT may represent a safe and effective treatment option for appendiceal abscess in early pregnancy, offering a promising alternative to conventional management strategies.