A complex case of acute abdomen

Acute abdomen during early pregnancy poses a diagnostic challenge, especially in patients with underlying chronic gastrointestinal diseases. A 36-year-old woman with Crohn’s disease and a confirmed 6-week intrauterine pregnancy presented with diffuse abdominal pain. Initial investigations, including MRI and ultrasound, were inconclusive. Diagnostic laparoscopy revealed malrotation of the large bowel and a perforated appendix, which was successfully managed with appendectomy and lavage. This case highlights the diagnostic complexity of abdominal pain in early pregnancy, particularly in patients with Crohn’s disease and anatomic variations such as intestinal malrotation.