Abdominal Pain In Pregnancy Research Articles

A 26 years old primigravida woman presented with abdominal cutaneous entrapment syndrome: a case report

BackgroundAbdominal cutaneous nerve entrapment syndrome (ACNES) is characterized by severe, mostly refractory, chronic pain due to the entrapment of the cutaneous branches of the lower torso intercostal nerves at the lateral edge of the rectus abdominis muscle. ACNES is rare compared to other pregnancy-related peripheral neuropathies and is often overlooked as a differential diagnosis for abdominal pain, despite the diagnosis relying primarily on patient history and physical examination. Emergency physicians and other medical personnel’s lack of exposure to such cases results in unnecessary laboratory requests, repeated visits, and increased fear and tension for the patient.Case presentationA 26-year-old primigravida on her second trimester of pregnancy presented to our Emergency department with persistent localized right upper quadrant abdominal pain. Despite repeated visit to the nearby hospital, no diagnosis was settled and the pain persisted. At our ED after a thorough history, physical examination and diagnostic test no abnormality was found. Finally Abdominal cutaneous nerve entrapment syndrome (ACNES) was considered and a mixture of 1 ml 2% lidocaine with adrenaline and 1 ml dexamethasone (4 mg) was infiltrated into the fascial plane in a fanning fashion into the most tender area using a modified technique and the patient reported significant improvement in pain.ConclusionAbdominal cutaneous nerve entrapment syndrome (ACNES) is a cause of abdominal pain in pregnancy that is often overlooked. The objective of this study is to describe a rare case of ACNES in a 26-year-old primigravida woman who presented to a low-resource emergency department to assist patient management.

WP7.1 - MRI for suspected acute appendicitis in pregnant females: What is the best imaging modality?

Abstract Introduction/Aims Acute appendicitis (AA) in pregnancy is the commonest non-obstetric cause of acute abdominal pain, but controversy surrounds the most appropriate imaging modality in this group. Ultrasound (USS) and Magnetic Resonance Imaging (MRI) have no known fetal risks. Hence, The World Society of Emergency Surgeons (WSES) recommends MRI in pregnant patients with suspected appendicitis, if available, but emphasises the preferred initial use of USS. This project explored the use of both imaging modalities in pregnant patients with suspected AA. Method Data was collected for all pregnant patients undergoing an MRI for suspected AA between 2015 and 2023. Results Of the 29 patients identified, the mean gestation was 23 weeks (range 2-36), and over half (15, 52%) of MRI scans were performed in 2022/3. Intra-abdominal pathology was seen in 17 (59%) patients, with 8 (47%) having MRI features of AA. 63% of those diagnosed with AA had an USS pre-MRI, and 40% identified the appendix as "normal." Other intra-abdominal pathologies picked up on MRI included pyelonephritis(1), small bowel obstruction(1), stercoral perforation(1), and ovarian torsion(2). Of the 8 patients with MRI-proven AA, all underwent appendicectomy: 3 laparoscopic, 2 open, and 3 with simultaneous Caesarean section, of whom 2 required ileocaecal resection. Conclusions Diagnosis of abdominal pain in pregnancy is a challenge. USS may be reasonably sensitive and specific in dedicated hands, but pathology may still be missed. In this patient group, for which appendicectomy for AA is associated with better outcomes than non-operative management, MRI should be obtained for accurate diagnosis.

A rare cause of abdominal pain in pregnancy - mesenteric artery thrombosis and miscarriage in a 34-year-old patient

BackgroundMesenteric arterial thrombosis is an extremely rare thrombotic event, especially during pregnancy, that can cause rapid fatal consequences unless the patient receives early definitive treatment.Case presentationWe report the case of a 34-year-old female presenting in her seventh week of gestation with severe abdominal pain who was promptly diagnosed with mesenteric artery occlusion amidst incipient miscarriage. The patient underwent a successful mesentery artery embolectomy, recovered and was later diagnosed with elevated factor VIII activity.ConclusionThe diagnosis of mesenteric ischemia should be considered in pregnant women presenting with severe abdominal pain and any prior predisposing factors. Our case highlights the pivotal role of the emergency physician in maintaining a high index of suspicion coupled with timely and determined action. The prognosis of this high mortality condition depends on prompt diagnosis, early definite management and successful multidisciplinary cooperation.

An Unexpected Cause of Abdominal Pain in Pregnancy: A Case Report

Acute abdomen during pregnancy is a condition that requires rapid diagnosis and treatment and threatens both maternal and fetal health. Adnexal masses may present different clinical presentations during pregnancy. The important thing is rapid diagnosis and application of the appropriate treatment method. Adnexal torsion should be kept in mind in the differential diagnosis of patients presenting with acute abdomen during pregnancy. Early diagnosis and treatment are vital for organ-preserving surgery.
 In this article, we presented the successful treatment of a patient with laparoscopy surgery who applied to our clinic due to acute abdomen and was diagnosed with left ovarian torsion at 12 weeks' gestation.

Maternal diaphragmatic hernia in pregnancy: A systematic review with a treatment algorithm.

Diaphragmatic hernia (DH) is extremely rarely described during pregnancy. Due to the rarity, there is no diagnostic or treatment algorithm for DH in pregnancy. To summarize and define the most appropriate diagnostic methods and therapeutic options for DH in pregnancy based on scarce literature. Literature search of English-, German-, Spanish-, and Italian-language articles were performed using PubMed (1946-2021), PubMed Central (1900-2021), and Google Scholar. The PRISMA protocol was followed. The search terms included: Maternal diaphragmatic hernia, congenital hernia, pregnancy, cardiovascular collapse, mediastinal shift, abdominal pain in pregnancy, hyperemesis, diaphragmatic rupture during labor, puerperium, hernie diaphragmatique maternelle, hernia diafragmática congenital. Additional studies were identified by reviewing reference lists of retrieved studies. Demographic, imaging, surgical, and obstetric data were obtained. One hundred and fifty-eight cases were collected. The average maternal age increased across observed periods. The proportion of congenital hernias increased, while the other types appeared stationary. Most DHs were left-sided (83.8%). The median number of herniated organs declined across observed periods. A working diagnosis was correct in 50%. DH type did not correlate to maternal or neonatal outcomes. Laparoscopic access increased while thoracotomy varied across periods. Presentation of less than 3 days carried a significant risk of strangulation in pregnancy. The clinical presentation of DH is easily confused with common chest conditions, delaying the diagnosis, and increasing maternal and fetal mortality. Symptomatic DH should be included in the differential diagnosis of pregnant women with abdominal pain associated with dyspnea and chest pain, especially when followed by collapse. Early diagnosis and immediate intervention lead to excellent maternal and fetal outcomes. A proposed algorithm helps manage pregnant women with maternal DH. Strangulated DH requires an emergent operation, while delivery should be based on obstetric indications.

Unilateral Non-Hemorrhagic Adrenal Infarction in Pregnancy: Case Series and Literature Review.

To summarize the evidence on non-hemorrhagic adrenal infarction (NHAI) and identify questions arising in diagnosis and management, cases in the PubMed database were merged with our case series. A total of 92 publications were retrieved, 15 of which reported on NHAI during pregnancy. Including the four in our case series, 24 cases have been described so far. Severe, unremitting pain requiring opioid analgesia was the leading symptom, often combined with nausea and vomiting. Laboratory results were non-contributory in most cases. Diagnosis was established via MRI in nine cases (37.5%) and via CT in six (25%); nine patients (37.5%) underwent both investigations. Location was predominantly on the right side (n = 16, 66.7%). In addition to analgesia, anticoagulation with heparin was commenced in 18 cases (75%). When thrombophilia screening was performed, major thrombogenic polymorphisms were detected in six cases (33.3%). One woman developed signs of adrenal insufficiency. The reported perinatal outcome was unremarkable. Unilateral NHAI has emerged as a rare but important cause of severe abdominal pain in pregnancy. The threshold to perform an MRI in pregnant women with characteristic clinical findings should be low. To prevent fetal radiation exposure, diagnostic imaging via CT should be avoided. In addition to symptomatic treatment with opioid analgesia, initiation of anticoagulant treatment should be strongly considered.

MR imaging of acute abdominal pain in pregnancy.

Abdominal pain in pregnancy is a diagnostic challenge with many potential aetiologies. Diagnostic imaging is a valuable tool in the assessment of these patients, with ultrasound commonly employed first line. MRI is an excellent problem-solving adjunct to ultrasound and has many advantages in terms of improved spatial resolution and soft tissue characterisation. This pictorial review aims to outline the role of MRI in the work up of acute abdominal pain in pregnancy and provide imaging examples of pathologies which may be encountered.

MR Imaging of Abdominal Pain in Pregnant Women: A Review of Common Obstetric and Non-Obstetric Pathologies

Acute abdominal pain in pregnancy is a common presenting symptom in the emergency setting, often requiring a quick imaging diagnosis to exclude etiologies associated with high maternal and fetal morbidity/mortality and guide proper patient management. Although US is the first-line imaging modality, many of the common causes of acute abdominal pain in pregnancy are not readily diagnosed sonographically.

Liver infarctions as the first manifestation of antiphospholipid antibody syndrome in pregnancy: a case report

BackgroundThe differential diagnosis of abdominal pain in pregnant women is broad. Liver diseases as the origin of abdominal pain in pregnancy are rare, and severe forms occur in less than 0.1% of pregnancies. Some disorders, such as hemolysis, elevated liver enzymes, low platelets (HELLP) syndrome and preeclampsia, are unique to pregnancy, while others, such as antiphospholipid antibody syndrome, may manifest in pregnancy but have consequences beyond the current pregnancy. All of them require prompt identification and treatment.Case presentationA 27-year-old Caucasian woman who was 15+1 weeks pregnant reported to the emergency department twice due to stabbing right-upper-quadrant abdominal pain. Initial laboratory testing revealed mild leukocytosis and slightly elevated liver enzymes. On second presentation, the patient was febrile and had an increased C-reactive protein concentration. Over the course of the next days, nonhemolytic anemia and thrombocytopenia emerged with elevated liver enzymes. Coagulation studies also revealed a prolongation of activated partial thromboplastin time. Magnetic resonance imaging showed nonspecific alterations in the right liver lobe, possibly corresponding to infection or infarction. A hepatic viral infection was ruled out. At that time, the most likely diagnosis was cholangitis with liver abscess formation, and antibiotic therapy was started. Further worsening of the anemia and thrombocytopenia, development of proteinuria, together with a miscarriage on the fourth day of hospitalization resulted in the tentative diagnosis of (triple-positive) antiphospholipid antibody syndrome, which was confirmed 12 weeks after the initial investigation. Treatment consisted of prompt anticoagulation with heparin and later on with a vitamin K antagonist as well as high-dose glucocorticoid therapy. There was no need for intravenous immunoglobulin therapy or plasma exchange, although we suspected a catastrophic form of antiphospholipid antibody syndrome due to infarctions of the liver, placenta, and possibly kidneys (proteinuria). The outcome was favorable.ConclusionWe report a 27-year-old pregnant woman whose abdominal pain was caused by liver infarctions as the first manifestation of catastrophic antiphospholipid antibody syndrome. The antiphospholipid antibody syndrome was possibly secondary to hitherto clinically silent systemic lupus erythematosus since the antinuclear antibodies were increased later on. Hydroxychloroquine therapy was initiated to prevent antiphospholipid antibody syndrome recurrence in a future pregnancy.

Казуистика в акушерстве: перекрут матки во время беременности

Uterine torsion is defined as the rotation of the uterus more than 45° around its long axis. This complication of pregnancy is very uncommon, with no more than 300 cases reported in medical literature in the past 150 years. Uterine torsion is a potentially dangerous obstetric condition that can lead to maternal and perinatal morbidity and mortality. This article discusses the incidence of uterine torsion, maternal and perinatal mortality rates. Risk factors include uterine fibroids, uterine malformations, abnormal fetal positions, polyhydramnios, multiple pregnancy, and cesarean section in medical history. Clinical manifestations are non-specific and diverse, sometimes asymptomatic course is noted. However, uterine torsion is often accompanied by acute abdominal pain, which requires differential diagnosis with placental abruption, uterine rupture, abdominal pregnancy, torsion of the uterine appendages, and acute appendicitis. In all cases of acute abdominal pain in pregnancy, especially when risk factors are present, uterine torsion should be excluded. Most cases of uterine torsion are diagnosed during laparotomy. Mandatory evaluation of anatomy in cesarean section is necessary to avoid incisions through the posterior uterine wall. It is emphasized that the effect of posterior hysterotomy on the course of future pregnancies is currently unknown. The analysis of 37 cases published in the English-language literature over the past 10 years is presented. Key words: fetal distress, posterior hysterotomy, cesarean section, uterine torsion, placental abruption

Rupture of Spleen During Pregnancy with Intrauterine Fetal Death Mimicking Rupture Uterus: A Case Report

Background: Splenic rupture in pregnancy or postpartum is a rare and frequently misdiagnosed event. The splenic rupture during pregnancy is difficult to diagnose because it shares signs and symptoms with other conditions such as uterine rupture and abruptio placentae. Case report: We report a case of a 26 years G3P2L2 who had splenic rupture following accidental fall from the stairs. She presented with acute abdominal pain with hemoperitoneum and intrauterine fetal death. Ultrasonography confirmed moderate amount of free fluid and fetal demise without any evidence of retroplacental clots. She was taken up for emergency laparotomy with a provisional diagnosis of rupture uterus. On laparotomy, massive hemoperitoneum due to splenic injury was noted. Hence, Splenectomy was done and she recovered without further complication. Splenic rupture should be considered in cases of trauma to the abdomen during pregnancy because of the risk of severe haemorrhage, shock, and possibility of pregnancy loss. The aim of the article is to highlight the fact that rupture of the spleen is an unusual but serious cause of acute abdominal pain in pregnancy and is associated with both maternal and fetal complications. Conclusion: Sudden abdominal pain, pallor, and hypotension following any trauma may be a sign of splenic rupture. Resuscita-tion of patients with immediate laparotomy should be done in these patients to avoid fetal and maternal morbidity and mortality. Hence, it should be one of the differential diagnoses in addition to abruptio placentae and uterine rupture in suspected cases of haemorrhagic shock.

Uterine Torsion at Term, An Unusual Cause of Abdominal Pain in Pregnancy

Uterine Torsion at Term, An Unusual Cause of Abdominal Pain in Pregnancy

AB144. SOH21AS086. Omental infarction: an unusual cause of abdominal pain in pregnancy

AB144. SOH21AS086. Omental infarction: an unusual cause of abdominal pain in pregnancy

Emergent MRI for acute abdominal pain in pregnancy-review of common pathology and imaging appearance.

Acute abdominal pain in pregnancy remains a clinically challenging presentation, often requiring imaging. The threat of morbidity and mortality to both mother and fetus necessitates quick and accurate imaging diagnosis, often via ultrasound. However, many of the common causes of acute abdominal pain are not readily diagnosed with sonography, and magnetic resonance imaging (MRI) is increasingly favored in this setting. The purpose of this review is to familiarize the reader with common pathologies which may be encountered in pregnant females presenting with acute abdominal pain requiring emergent MRI.

2699 An Uncommon Cause of Vomiting and Abdominal Pain in Pregnancy

INTRODUCTION: Anisakis is a zoonotic parasitic disease that infects marine mammals. Gastrointestinal anisakiasis is caused by consumption of undercooked or raw seafood infected by nematodes of the Anisakis species. While it is common in Asia it is an uncommon infection in North America with only a few reported cases. Here we present a case of gastric anisakiasis in a pregnant woman complicating the diagnosis and management. CASE DESCRIPTION/METHODS: A 32 year old newly pregnant female presented to the infectious disease clinic with acute onset abdominal pain and emesis. She reported finding two mobile “worms” in raw salmon, after ingesting six ounces of the fish, a day before. A specimen was sent to the microbiology laboratory with the preliminary read concerning for roundworm. Given the concern for anisakiasis, pregnancy status and risk of perforation, she was directly admitted for upper endoscopy. This revealed a thin, translucent, 20 mm × 1 mm worm burrowed into the greater curvature of the proximal antrum. The worm was removed in entirety with cold biopsy forceps and sent to microbiology. Biopsies were taken from the site of burrow. Pathology was consistent with mild gastritis with focally increased eosinophils and no remnant of the parasite. The worm was identified as anisakis species. The patient’s symptoms resolved spontaneously. Her pregnancy limited evaluation of the remainder of her G.I tract for evidence of infection. Since she had no symptoms of obstruction, she was discharged with instructions to complete a bowel purge upon returning home. DISCUSSION: Gastric anisakiasis is uncommon in the U.S. In addition, this case was complicated by the patient’s pregnancy, precluding the use of imaging techniques such as CT scans to help narrow the diagnosis in suspected anisakiasis and exonerate complications. Obstruction is a commonly reported complication for which there has been reported success with Albendazole therapy, undesirable in this case, being pregnancy category C. Another reported and somber complication includes perforation from the burrowing of untreated parasites. To minimize adverse outcomes with imaging and antiparasitic therapy, our patient underwent curative endoscopic therapy followed by a bowel purge to empirically purge remaining parasites from the distal G.I tract. With globalization of cuisine and increasing consumption of raw fish in the west, physicians should have a heightened suspicion of parasitic infections such as anisakis given the significant sequalae of untreated infection.

Acute gravid uterus torsion: A rare and dangerous obstetric emergency.

Our case suggests that uterus torsion should always be considered in the differential diagnosis of women presenting with acute abdominal pain 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.

Surgical causes of acute abdominal pain in pregnancy

Key content Abdominal pain in pregnancy is common, with a differential diagnosis that can encompass obstetric, surgical and medical conditions. Presentation of common surgical problems can be atypical in pregnancy, potentially delaying diagnosis. Surgical causes of abdominal pain to consider in pregnancy include appendicitis, cholecystitis, bowel obstruction, ureteric obstruction, pancreatitis and aneurysm rupture, most commonly involving the splenic artery. The management of surgical conditions in pregnancy requires continuing evaluation and potential modification to balance the medical, surgical and obstetric challenges. Management of the pregnant woman with a surgical cause of abdominal pain requires collaborative, multispecialty practice to optimise care of the mother and baby. Learning objectives To highlight the differential diagnoses of abdominal pain in pregnancy. To develop a structured assessment process for pregnant women with abdominal pain. To update the obstetrician on the priorities of surgical management for abdominal pain in pregnancy. Ethical issues Evaluating the risks of surgical interventions on the mother and baby with the high potential for premature delivery.

Intussusception Caused by Colon Cancer in Pregnancy

Intussusception is a common in pediatric age group. But it is rare in adults. And intussusception caused by tumor account for 1% of bowel obstructions in adult. Intussusception is an extremely rare cause of abdominal pain in pregnancy. In particular, cases of Intussusception due to colorectal cancer during pregnancy have never been reported in Korea. Our patient is a 34 years old woman who presented at 14 weeks of her second pregnancy. She presented with right lower abdominal discomfort and intermittent palpable mass which was usually spontaneously resolved. In the MRI study, pathologic asymmetric wall thickening was still noted and ileocolic intussusception was noted, and in colonoscopy, there was ulcerofungating mass around ileocecal valve which may be a leading point of intussusception. Biopsy was done. Pathologic finding was poorly differentiated adenocarcinoma. Under the patient agreement, we performed dilatation and curettage and laparoscopic right hemicolectomy and lymph node dissection. Now she is receiving a FOLFOX chemotherapy.

Antenatal cough-induced rib fractures: an uncommon cause of upper abdominal pain

Rib fractures secondary to cough are an uncommon cause of thoracic or abdominal pain in pregnancy. There is little in the literature describing this accidental phenomenon during pregnancy and why fractures occur so easily. In most cases, they are diagnosed fortuitously during the course of investigation for other more common causes of acute chest and upper abdominal pain. We report the case of a 38 year old, G11P5 who was 35 weeks pregnant, admitted with sudden onset right upper quadrant and right sided chest pain post coughing. This pain was caused by a 10th right rib fracture which was managed conservatively with analgesia. Despite numerous reviews, the fracture was not diagnosed. The patient also suffered a rib fracture on the contralateral side in a previous pregnancy.