Abdomen In Pregnancy Research Articles

Laparoscopy in the gynecological acute abdomen in pregnancy

Acute abdomen in pregnancy can be divided into pregnancy-related and non-pregnancy-related type. This article reviewed the different types of acute abdomen caused by gynecological problems during pregnancy. Also, the progress of laparoscopic surgical technique and the perioperative management and the influence of the operation on pregnancy outcomes in patients who developed acute abdomen and underwent laparoscopic surgery in pregnancy were also analyzed, to provide information for the application of emergency laparoscopic surgery in pregnancy. Key words: Abdomen, acute; Pregnancy complications; Laparoscopy

Laparoscopic surgery for non-obstetric acute abdomen in pregnancy: A retrospective case series review.

Background:Laparoscopic techniques have been used during pregnancy by obstetricians since the 1970's, primarily to diagnose and treat ectopic and heterotopic pregnancies. Pregnancy was considered as an absolute contraindication to laparoscopy by surgeons as recently as 1991, and a few still doubt the safety of minimal access in gravid patients. When an emergent operation is indicated, the surgery should not be withheld on the sole basis of patient's gravid state. On the contrary, the alleviation of maternal disease is thought to take priority because the health of the foetus is dependant on the mother.Materials and Methods:This is a retrospective study of a case series of 18 obstetric patients who presented with non-obstetric causes of acute abdomen requiring surgical intervention. Ultrasonography and magnetic resonance imaging (MRI) along with other laboratory investigations were carried out to reach the diagnosis. Laparoscopic surgery was considered as the modality of treatment. All the patients were given the necessary care post-surgery and were followed up till parturition to look for any complications.Results:The data were analysed considering the presentation, diagnostic variations and the surgical modifications statistically.Conclusion:The decision of surgery should be prompt and should be weighed against complications of conserving the patient. Due to the diagnostic limitations of ultrasonography, MRI should be coupled to confirm the diagnosis. Laparoscopy offers less analgesic requirements and shorter hospital stay. The operative time is highly subjective to the experience and training of the surgeon and the laparoscopic set-up itself.

Acute Abdomen in Pregnancy

Acute Abdomen in Pregnancy

Acute Abdomen in Pregnancy

Acute Abdomen in Pregnancy

A prospective cohort study of non-obstetric surgical emergencies complicating pregnancy

Background: During pregnancy, 0.2% to 1.0% of women require general surgery for a non-obstetric problem. The evaluation, work-up, and management of pregnant patients are essential in the practice of emergency medicine to avert maternal and fetal morbidity and mortality. The aims and objectives of this study were to study the common causes of acute abdomen in pregnancy and there management. Methods: Ours was a prospective cohort study of 50 pregnant patients presenting with a non-obstetric surgical emergency over a period of 1 year in a tertiary care hospital of a developing area.Results: The mean age of the patients was 27.4 ± 4.73 years with most of them being in the age group of 26- 30 years. Majority of patients presented in the 2nd trimester [22 (44%)]. Ultrasonography was used as the diagnostic modality of choice in 49 (98%) patients. Acute cholecystitis was the most common surgical emergency in our study group accounting for 28% of all the emergencies, followed by acute appendicitis (14%), urinary tract infections (12%), urolithiasis (12%) and acute pancreatitis (6%).Conclusion: Early suspicion and serial examination in pregnancy may result in appropriate interventions for non-obstetric surgical emergencies. Surgeons should not be hesitant in ordering imaging modalities. Ultrasonography is most common and most useful diagnostic modality in pregnancy.

Management of acute abdomen in pregnancy: current perspectives.

Acute abdomen in pregnancy represents a unique diagnostic and therapeutic challenge. Acute abdominal pain in pregnancy can occur due to obstetric factors as well for reasons that are unrelated to pregnancy. The diagnostic approach of acute abdomen during pregnancy can be tricky owing to the altered clinical presentations brought about by the anatomical and physiological changes of gestation along with the reluctance to use certain radiological investigations for fear of harming the fetus. Delay in diagnosis and treatment can lead to adverse outcomes for both the mother and fetus. In this article, we attempt to review and discuss the various etiologies, the current concepts of diagnosis, and treatment, with a view to developing a strategy for timely diagnosis and management of pregnant women presenting with acute abdominal pain.

Perforated Meckel's Diverticulitis Complicating Pregnancy at 28 Weeks' Gestation Misdiagnosed as Appendicitis

Perforated Meckel's diverticulum is an extremely rare cause of an acute abdomen in pregnancy. Its clinical presentation is similar to that of appendicitis and diagnosis is delayed in most cases. We present a patient who developed increasing abdominal pain and leukocytosis at 28 weeks of gestation. She was misdiagnosed with appendicular peritonitis until acute exploratory laparotomy. Regarding related published cases up to now, most cases did not make a correct preoperative diagnosis of Meckel's diverticulum. This case suggests that Meckel's diverticulum in pregnancy may have serious consequences. A high index of suspicion and a low threshold for surgical intervention are required to minimize morbidity and mortality.

Can Patients with Appendicitis in Pregnancy be Operated in Secondary Hospital: A retrospective Study

Appendicitis is the most common non-obstetric cause of acute abdomen in pregnancy. Diagnosis of appendicitis becomes difficult with the change of appendiceal position during pregnancy. Late diagnosis and treatment increase the likelihood of developing perforation. In this study, we aimed to evaluate perioperative outcomes of appendicitis in pregnant patients in secondary hospitals in the light of the literature. 29 pregnant women who performed appendectomy between April 2012 and July 2017 were included in the study. Patients were evaluated according to age, gestational age, white blood cell count, percentage of neutrophil count, C-reactive protein level, ultrasonographic findings, pathologic results, duration of hospitalization and complications. Out of the 29 pregnant patients, 9 (31.0%) patients had surgery during the first trimester, 13 (44.8%) during the second trimester and 7 (24.2%) during the third trimester. Median white blood cell count was 12870 K/mm3 (min-max;7170-25210). Negative laparotomy rate was %31.0. Median duration of hospitalization was 3.24 days (2-7). Morbidity was observed in 2 (6.9%) of 29 patients. Intra-abdominal abscess was observed in one patient and colonic fistula was observed in one patient. Our results demonstrated that appendectomy and follow-up of pregnant patients with acute appendicitis can be performed at secondary hospitals.

A third-trimester rupture in a scarred uterus: a case report

Acute abdomen in pregnancy is a diagnostic and therapeutic challenge. Among its causes, uterine rupture complicates a minority of surgical emergencies with severe consequences, but occasionally constitutes an urgent medical situation in those pregnant women with uterine surgery history, especially in the third trimester. The authors present a case with an atypical presentation of uterine rupture occurring at 34+4 weeks of gestation, simultaneously suspected with acute appendicitis. Due to the potentially devastating outcomes and her surgical history of laparoscopic myomectomy, the suspected case was offered surgical emergencies. The authors' aim is to assess whether what they decided has helped to protect both mother and the unborn in this emergency. The risk of previous uterine surgeries for pregnant women, available differential diagnoses, and finer treatment points for this population are all discussed at length.

Massive Pyonephrosis Presenting as a Mammoth Tumour in Pregnancy: A Case Report

The overall incidence of ovarian tumours in pregnancy is 2.4-5.7% and because of the asymptomatic nature of ovarian mass it is usually diagnosed in late pregnancy when there may be symptoms produced by it. Due to the similarity of symptoms, there has always been perplexity when a patient presents with mass per abdomen in pregnancy. During pregnancy, mild hydronephrosis is considered a normal phenomenon and may be present in up to 90% of pregnancies. Dilation is usually more pronounced on the right kidney and after mid-pregnancy. Here, we present a case which presented as a huge abdominal mass in pregnancy which was mistaken to be an ovarian mass in pregnancy and then later diagnosed as pyonephrosis.

Changing management of gallstone-related disease in pregnancy – a retrospective cohort analysis

Objectives: Gallstone-related disease is the second most common non-obstetric cause, following appendicitis, for acute abdomen in pregnancy. This study aimed to investigate treatment strategies, changes over time and outcome.Materials and methods: All consecutive patients with symptomatic gallstone-related disease during pregnancy admitted to Skane University hospital in Lund and Malmö 2001–2015 were analysed retrospectively. Information regarding the patient, pregnancy and fetus/child was recorded. The material was analysed by dividing it into two equal time periods and by comparing conservative management and surgical intervention.Results: We included 96 patients with 97 pregnancies. The age was 30 (26–34) years and BMI 28 (24–31). Median length of pregnancy at first admission was 23 (13–31) weeks. The three most common diagnoses were biliary colic (n = 63), cholecystitis (n = 22) and acute pancreatitis (n = 16). Conservative treatment was practiced in 62 (64%) patients and intervention in 35 (36%). Conservatively treated patients were admitted later during pregnancy (week 26 (20–33) versus 17 (10–22), p < .001). Surgically treated patients had a longer total length of stay (all admissions) than conservatively treated patients (p = .001), less readmissions (p = .001) and equal birth outcome. Surgical intervention was more common in the later time period (48% versus 22%, p = .011). Of the conservatively treated patients, 56% were subjected to surgical intervention within 2 years after delivery.Conclusions: We found that intervention was more common in the later time period, with good results concerning safety, and less readmissions. A majority of the conservatively treated patients had surgical intervention within two years after delivery. Our results support surgical intervention in pregnancy.

Spontaneous Renal Calyceal Rupture: A Rare Cause of an Acute Abdomen in Pregnancy

Spontaneous Renal Calyceal Rupture: A Rare Cause of an Acute Abdomen in Pregnancy

Update on the Management of Non-obstetric Acute Abdomen in Pregnant Patients

Acute abdomen is a rare entity in the pregnant patient, with an incidence of one in 500–635 patients. Its appearance requires a quick response and an early diagnosis to treat the underlying disease and prevent maternal and foetal morbidity. Imaging tests are essential, due to clinical and laboratory masking in this subgroup. Appendicitis and complicated biliary pathology are the most frequent causes of non-obstetric acute abdomen in the pregnant patient. The decision to operate, the timing, and the surgical approach are essential for a correct management of this pathology. The aim of this paper is to perform a review and update on the diagnosis and treatment of non-obstetric acute abdomen in pregnancy.

Actualización en el manejo del abdomen agudo no obstétrico en la paciente gestante

Acute abdomen is a rare entity in the pregnant patient, with an incidence of one in 500-635 patients. Its appearance requires a quick response and an early diagnosis to treat the underlying disease and prevent maternal and fetal morbidity. Imaging tests are essential, due to clinical and laboratory masking in this subgroup. Appendicitis and complicated biliary pathology are the most frequent causes of non-obstetric acute abdomen in the pregnant patient. The decision to operate, the timing, and the surgical approach are essential for a correct management of this pathology. The aim of this paper is to perform a review and update on the diagnosis and treatment of non-obstetric acute abdomen in pregnancy.

Electronic Poster Presentations, Maternal Fetal Medicine

Electronic Poster Presentations, Maternal Fetal Medicine

Cope's Early Diagnosis of the Acute Abdomen (21st edn)

Zachary Cope published the first edition of this treatise on the diagnosis of the acute abdomen in 1921. From the outset, he emphasised the importance of personal experience and clinical observation, confirmed frequently by everyday practice in arriving at early and timely diagnoses. Eighty-four years later in this latest edition, Silen has remained true to Cope's key ideology. The style is somewhat reminiscent of a grand master such as Goligher giving out useful tips gleaned from a lifetime's experience on an imaginary ward round. Unlike Goligher, the text is at times awkward and unnecessarily long-winded. Nevertheless, there is no doubting the author's dedication to his subject, including a description of Cope's own signs and symptoms during an attack of cholecystitis culminating in a laparotomy for a perforated gall bladder! The book is aimed at the tyro dealing with the unselected general surgical ‘take’ and would form a useful reference in establishing a clinical diagnosis. Its layout includes the regular lists of differential diagnoses followed by a detailed explanation of how they differ from one another. For example, there is particular detail on how to differentiate intestinal obstruction from other abdominal catastrophes by careful attention to the nature, colour and frequency of vomiting. There are pearls of wisdom even for the experienced clinician and clear descriptions of clinical signs, such as liver resonance in perforated peptic ulceration, and how to determine abdominal pain of thoracic origin. Contained within its 26 chapters, there are useful sections covering the acute abdomen in pregnancy, the immunocompromised, patients with impaired sensation following injury and operation, as well as a discussion of those conditions that mimic abdominal disease. There are 16 black and white plates, predominantly of plain abdominal films, illustrative of the common conditions described in the text. This book champions the skills of clinical diagnosis founded on the cornerstones of careful history taking and examination. Both Cope and Silen eschew the modern doctor's reliance on laboratory tests and cross-sectional imaging, constantly stressing that many diagnoses can be arrived at purely through careful attention to detail. This mantra is repeated throughout and bears an important message to all of us lazily reaching for the CT scan request card.

Rare causes of acute abdomen in pregnancy: “ultrasound to the rescue”. A review of two cases

Abstract Acute abdomen in pregnancy poses special challenge to the pregnant woman, her unborn infant, and the attending physician. The problems are multifactorial, as the physiological changes in pregnancy mask some of the clinical signs that can be elicited in making accurate diagnosis. Some diagnostic modalities are not feasible in pregnancy because of their effects on the fetus. Another dilemma is that two lives are at stake. It becomes even more challenging when one is faced with rare causes. For these reasons, the choice of diagnostic modality becomes critical. The chosen diagnostic modality should not only be readily available, non-invasive, least hazardous to the mother and fetus, but should also provide adequate information to enable accurate diagnosis. Ultrasonography provides such an opportunity and should be utilized whenever the need arises. We present two cases of acute abdomen in pregnancy managed at Abubakar Tafawa Balewa University Teaching Hospital: one was seen in the third trimester and the other in the first trimester, each with its peculiar presentation. The review is meant to alert obstetricians on the critical role of ultrasound in enhancing accurate diagnosis in the face of a complex clinical condition like acute abdomen in pregnancy.

Meckel's Diverticulitis as a Cause of an Acute Abdomen in the Second Trimester of Pregnancy: Laparoscopic Management.

Introduction. Meckel's diverticulitis is an extremely rare cause of an acute abdomen in pregnancy. Its clinical presentation tends to be rather unusual and therefore commonly delaying diagnosis. The surgical method of exploration can be either by laparoscopy or through an open incision. Case Report. We report a case of a 34-year-old, P1 with previous Caesarean section, who presented at 20 weeks with worsening right-sided abdominal pain, distention, and peritonism. Ultrasound scan showed an area of a possibly thickened loop of bowel inconsistent with an appendicitis. The findings at laparoscopy were purulent fluid in the pelvis, a congested appendix, and inflamed Meckel's diverticulum. An appendectomy and excision of the diverticulum was performed using stapler technique. Discussion. Meckel's diverticulitis in pregnancy can have nonspecific presentation and poses difficulties for preoperative diagnosis. Delay in diagnosis and management poses significant maternal and fetal risks. The use of laparoscopy if the gestational age and uterine size permit its use allows a thorough exploration of the abdominal cavity and management of rarer and unexpected pathology. Laparoscopic management of acute abdomen in the midtrimester of pregnancy has been found to be safe and effective.

Spontaneous rupture of the urinary bladder in the third trimester of pregnancy

Spontaneous rupture of the urinary bladder is defined as rupture of the urinary bladder into the peritoneal cavity without a history of trauma 1. Aetiological factors implicated include but are not limited to radiotherapy, chronic infective diseases like tuberculosis, necrotizing cystitis and in pregnancy, bladder injuries caused in the event of uterine rupture 2. Its incidence is 1 in 126,000 hospital admissions 3. We report a rare case of spontaneous intraperitoneal rupture of the urinary bladder in the early third trimester of pregnancy. This report highlights the diagnostic challenges obstetricians and surgeons may encounter with presentations of acute abdomen in pregnancy. The patient presented with acute abdominal pain, voiding difficulty with pyrexia and features of peritonitis. At laparotomy, 3.5 litres of urine were drained from the abdominal cavity and a 6cm rent in the vault of the bladder was found. Laparotomy, bladder repair with antibiotic cover and indwelling catheterization were the basis for a favourable outcome.

Severe acute pancreatitis in pregnancy.

This is a case of a pregnant lady at 8 weeks of gestation, who presented with acute abdomen. She was initially diagnosed with ruptured ectopic pregnancy and ruptured corpus luteal cyst as the differential diagnosis. However she then, was finally diagnosed as acute hemorrhagic pancreatitis with spontaneous complete miscarriage. This is followed by review of literature on this topic. Acute pancreatitis in pregnancy is not uncommon. The emphasis on high index of suspicion of acute pancreatitis in women who presented with acute abdomen in pregnancy is highlighted. Early diagnosis and good supportive care by multidisciplinary team are crucial to ensure good maternal and fetal outcomes.