Abstract
BackgroundAcute abdomen in advanced pregnancy is one of the most challenging surgical situations. In life-threatening situations, despite optimal management, foetus distress and preterm delivery may occur. Although laparostomy is a useful treatment of abdominal sepsis, its successful management has not been reported previously in pregnant women.Case30-year-old woman at 23 week of pregnancy was investigated for non-specific abdominal pain. Surgical exploration revealed extensive ischemic bowel necrosis. Multiple segmental resections were performed and abdomen was left open with vacuum assisted dressing, maintained for 48 hours. At the third surgical look the continuity was restored and abdominal wall closed. The foetal condition stayed unperturbed under pharmacologic tocolysis. Pregnancy was carried to full term delivery.ConclusionOpen abdomen strategy can be successfully applied in pregnant woman.
Highlights
Acute abdomen in advanced pregnancy is one of the most challenging surgical situations
Open abdomen strategy can be successfully applied in pregnant woman
During pregnancy the usual clinical presentation is masked by gravid uterus and physiological changes
Summary
Acute abdominal pain in advanced pregnancy remains a diagnostic and management challenge. Imaging procedures can rarely help to resolve a diagnostic dilemma because of modified abdominal anatomy and limits in x-ray techniques use [1]. For these reasons the rate of accurate preoperative diagnosis is still considerably lower than in non-pregnant patients. A 30-year-old woman was admitted to the emergency department at 23 week of her second pregnancy for nonspecific abdominal pain She was known for previous minor abdominal surgery including mesenteric cyst excision and vesicoureteral reflux surgery in childhood followed by laparoscopic adhesiolysis 10 years later. After 48 hours of open abdomen management, the intestinal continuity was restored leaving 110 cm of viable small bowel.
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