Introduction:Bowel perforation needs an urgent clinical intervention and it significantly increase the mortality in the patients. Bowel perforation is rarely seen in post-partum mother. (1) Bowel perforation after a normal vaginal delivery (NVD) is rarer than a Caesarean section (C-section). (1)Appendicitis can be operated during pregnancy but post-partum appendicitis is very rare. (2) In perforated appendicitis, “gas under diaphragm” in plain radiograph is also a very rare incident. (3). Post partum perforated appendicitis is also rarely reported. The most common differential diagnosis are peptic perforation and bowel perforation. Other differential diagnosis are Meckel’s diverticulitis, Ischemic colitis, bowel obstruction, cholecystitis, Fitz Hugh Curtis syndrome, round ligament syndrome, pelvis thrombophlebitis, torsion of adnexal structures etc.From early 1900, surgeon’s are publishing papers related to appendicitis during pregnancy, so currently surgeons are well aware of the diagnosis and management of the appendicitis during pregnancy. Babler had published a paper related to this in 1908. (4) Harris J Timerman had published a paper in 1942, presenting two cases of post-partum appendicitis. (5).So, here we are presenting a very rare case of post-partum perforated appendicitis, a diagnostic dilemma. The abdominal pain and tenderness can be misinterpreted as labour pain and the septic peritonitis can lead to a preterm labour and preterm delivery. (6)Highlights:Post-partum Bowel perforation and Post Partum appendicitis are rare“Gas under diaphragm” due to perforate appendix is also rarePerforated Appendicitis in post-partum period is also rare
