We report the case of a 24yearold woman at 24 weeks of gestation who presented with abdominal pain for 4 days accompanied with abdominal distension, tenderness and guarding in right lower quadrant. Acute appendicitis is the most common general surgical problem encountered during pregnancy. Non obstetric causes and presentation of acute abdomen. Meckels diverticular perforation is an extremely rare cause of acute abdomen during pregnancy. Fetal medicine, department of obstetrics and gynecology, university of utah and intermountain healthcare, salt lake city, ut, usa. Limited knowledge and experience among radiologists in using mri to. As for nonobstetric causes, any gastrointestinal gi disorder can occur during pregnancy. The normal anatomical and physiological changes during pregnancy can alter the classical clinical presentation of acute abdomen. The objective of this study was to study the profile of pregnant. The book highlights the importance of a rapid diagnosis to avoid serious consequences for both the mother and the fetus. Meckels diverticular perforation is a rare cause of acute abdomen during pregnancy. An absolute limiting factor for performing laparoscopy in pregnancy is the enlarged uterus when it extends beyond the umbilicus, and so in the. Acute abdomen in pregnancy represents a challenge for the treating surgeon because its symptoms, such as nausea, vomiting and abdominal pain resemble the normal symptoms of pregnancy.
Many health care providers care for pregnant women including attending physicians, resident physicians, advanced practice nurses, certified nurse, midwives, labor and delivery. Gastrointestinal gi causes of acute abdomen that are incidental to pregnancy include the following. The diagnosis and management of the acute abdomen in. This text is intended to serve as a reference guide for clinicians who consult pregnant.
Abdominal pain in early pregnancy may be due to an ectopic pregnancy. This occurs more often in the second tri mester of pregnancy. It has high sensitivity and specificity for diagnosing the common nonobstetric causes of acute abdomen during pregnancy, namely, appendicitis and cholecystitis. Standard imaging techniques need to be adapted to reduce harm to the fetus from xrays due to their teratogenic and carcinogenic potential. Meckels diverticulitis as a cause of an acute abdomen in the. The diagnosis and management of the acute abdomen in pregnancy content this text is intended to serve as a reference guide for clinicians who consult pregnant women presenting with abdominal and pelvic pain.
Despite advancements in medical technology, preoperative diagnosis of acute abdominal conditions is. Nonobstetrical acute abdomen during pregnancy as a. Acute abdomen in pregnancy remains one of the most challenging diagnostic and therapeutic dilemmas today. Ultrasound remains the primary imaging investigation of the pregnant abdomen.
Mr imaging of acute abdomen during pregnancy certificate of merit rsna 2004 mr imaging of acute abdomen during pregnancy aytekin oto, padmavathi n. Conditions resulting from pregnancy that cause acute abdomen in early pregnancy include the following. The acute abdomen during pregnancy sharp, howard t. Abdominal pain is one of the most common disorders of pregnancy. The diagnosis and management of acute abdominal pain in pregnancy is often a challenging task. Specialists in obstetrics and gynaecology may be quick to attribute symptoms to obstetric complaints and fail to recognise other important differentials. 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. To identify the nonobstetric causes and presentation of acute abdomen among pregnant women. Despite advancements in medical technology, preoperative diagnosis of acute abdominal conditions is still inaccurate. Radiation and pregnancy centers for disease control and. Diagnosis of the acute abdomen in pregnancy remains one of the most challenging diagnostic and therapeutic dilemmas. Jan 11, 2019 diagnosis of the acute abdomen in pregnancy remains one of the most challenging diagnostic and therapeutic dilemmas.
The incidence of acute abdomen during pregnancy is 1 in 500635. Ernst, mert koroglu, alfred gei, george saade powerpoint ppt presentation free to view. During the first 2 weeks postconception, the health effect of concern from an exposure of. Therefore, an acute abdomen during pregnancy often presents atypically and it could be difficult to distinguish a tense abdomen from a normal pregnancy 32, 37 and to detect an acute abdomen. Pdf on dec 1, 20, weijing lee and others published acute abdomen during pregnancy find, read and cite all the research you need on researchgate. Comparing the diagnostic performance of mri versus ct in the evaluation of acute nontraumatic abdominal pain. The fallopian tube torsion is a rare cause of acute abdomen and even more rare during pregnancy. Acute abdomen in pregnancy represents a unique diagnostic and therapeutic challenge.
The clinician has the opportunity to care for two or more patients, as the. During the first trimester of pregnancy, common causes. Surgical causes of abdominal pain to consider in pregnancy include appendicitis. There are several reports of the acute abdomen during pregnancy 6,7 but no report of hydrosalpinx with acute abdomen in the third trimester of pregnancy. Surgical causes of acute abdominal pain in pregnancy. Acute pancreatitis ap during pregnancy is a rare disease with an estimated incidence rate of about 1 case per to 10 000 pregnancies. Review nonobstetrical acute abdomen during pregnancy. This was a cross sectional hospitalbased study among 128 pregnant women by face to face interview using a semistructured questionnaire. An absolute limiting factor for performing laparoscopy in pregnancy is the enlarged uterus when it extends beyond the umbilicus, and so in the third trimester open exploration is usually the standard. It provides an update on recommendations, guidelines and scenarios to help clinicians make correct and prompt decisions.
Sep 08, 2018 in pregnancy, intractable abdominal pain can be safely evaluated using mri. Evidence suggests that laparoscopy can be performed safely during any trimester of pregnancy and has the same indications in pregnant and nonpregnant patients when treating acute abdominal processes. The acute abdomen during pregnancy critical care obstetrics. Surgical causes of acute abdominal pain in pregnancy woodhead.
The incidence of acute abdomen during pregnancy is 1 in 500635 pregnancies. We will present a case of an acute abdomen during pregnancy due to. Meckels diverticulitis as a cause of an acute abdomen in. Acute abdominal pain in pregnancy presents diagnostic and therapeutic challenges. Pregnant patients with an acute abdomen should, in general, be treated as their non.
Acute abdomen and abdominal pain in pregnancy sciencedirect. Mri evaluation of acute abdominal pain in the pregnant patient. Diagnosis of colorectal cancer during pregnancy is usually made at an advanced stage due to unspecific symptoms. In 1933, regad reported 201 cases of tubal torsion, 12% of these occurred in pregnant women n 24. It occurs most frequently in patients aged 50, although some studies report increasing incidence in women under the age of 40.
Nonobstetrical acute abdomen during pregnancy crosbi. It is the imaging technique of choice in pregnancy due to its availability, portability, and lack of ionizing radiation. Clearly, the case of a pregnant patient with acute abdomen is a clinical scenario that overlaps specialties. In the vast majority of women, abdominal discomfort or pain is due to the stretching of the muscles and ligaments supporting the uterus. In pregnancy, intractable abdominal pain can be safely evaluated using mri. Despite advancements in medical technology, preoperative diagnosis. Acute intestinal obstruction complicating pregnancy. Colorectal carcinoma is a rare but potentially fatal disease complicating pregnancy. It has a variable clinical presentation, and preoperative diagnosis is very difficult. Ppt acute abdomen in pregnancy powerpoint presentation. Acute abdomen during pregnancy goran augustin this is the second edition of a wellreceived book that reflects the state of the art in diagnosis and treatment of acute abdominal disorders in.
Incidence of acute abdomen during pregnancy is 1 in 500635. Hydrosalpinx with acute abdominal pain during the third. Emergency general surgery in pregnancy trauma surgery. 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. Main the diagnosis and management of the acute abdomen in pregnancy the diagnosis and management of the acute abdomen in pregnancy this text is intended to serve as a reference guide for clinicians who consult pregnant women presenting with abdominal and pelvic pain. Clinical examination of pregnant patients also not so easy, so clinical intrepretation also becomes difficult. Meckels diverticular perforation presenting as acute abdomen. Acute abdominal pain in pregnancy can occur due to obstetric factors as well for reasons that are unrelated to pregnancy. Abdominal pain or acute abdomen due to complications of pregnancy early pregnancy up to 24 weeks the enlarging gravid uterus becomes an abdominal organ by approximately 12 weeks and hence, disorders of pregnancy may present with abdominal pain or acute abdomen, depending on the nature and severity of the underlying pathology.
However, various complications of pregnancy as well as conditions that are associated with or unrelated to pregnancy may cause abdominal pain or acute abdomen. As pregnancy stretches the anterior abdominal wall, the resulting peritoneal signs are often different from what is expected in the nonpregnant patient owing to lack of contact with the underlying inflammation. 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. This book provides a detailed description of the various clinical scenarios in which we encounter acute abdominal conditions in pregnant patients. Pdf non obstetric acute abdomen in pregnancy an experience. Department of surgery, university hospital center zagreb, zagreb, croatia.
To date, no deleterious effects to the developing fetus exposed to mri have been reported. It addresses a wide range of conditions, whether associated with or incidental to pregnancy, ranging from very rare to more common ones, such as acute appendicitis and acute cholecystitis. Aug 30, 20 acute abdominal pain in pregnancy presents diagnostic and therapeutic challenges. A wide range of conditions are addressed, including some which are very rare as well as. Acute appendicitisthe most common cause of acute abdominal pain in pregnancy is acute appendicitis, affecting as many as 1 in 766 pregnancies. Laparoscopic management of acute abdomen in the midtrimester of pregnancy has been found to be safe and effective. During pregnancy, the uterus can increase from a mere 70 to 1,110 g with a resultant intrauterine volume of at least 5 l. Assessment of abdominal pain in pregnancy differential. This book, in its 2nd edition, explains the diagnostic and therapeutic principles for all causes of acute abdomen during pregnancy.
Approximately 1 in 500 pregnancies is complicated by a nonobstetric surgical condition. Abdominal examination distinguish extrauterine from uterine tenderness, lie the patient on her side, thus displacing the uterus. Comparing the diagnostic performance of mri versus ct in the evaluation of acute nontraumatic abdominal pain during pregnancy. The cardinal diagnostic signs of acute abdomen are altered by the anatomic displacement of the pregnant uterus. Because the embryo is made up of only a few cells, damage to one cell, the progenitor of many other cells, may cause the death of the embryo, and the blastocyst may fail to implant in the uterus. Furthermore, it sheds light on the different imaging modalities of rare pathologies that can occur during pregnancy, helping clinicians and radiologists to better define underlying cases.
Full text management of acute abdomen in pregnancy. Learning objectives describe the rationale, risks, and technique, for imaging the acute abdomen in pregnancy with mri recognize common causes of acute abdominal pain in pregnancy seen at mri knowledge gap addressed. The diagnosis and management of the acute abdomen in pregnancy pdf author peter bogach greenspan isbn 331962282x file size 6. Introduction laparoscopy during pregnancy diagnostic imaging during pregnancy appendicitis during pregnancy cholecystitis during pregnancy bowel obs. May 18, 2018 acute abdomen, as it presents with pregnancy, has many possible causes. Acute abdomen and trauma during pregnancy scott alexander harvey introduction pregnancy induces different physiologic and anatomic factors that make evaluation and treatment of a pregnant woman different than that of the nonpregnant individual.
Peritoneal signs may be absent in pregnancy, as the uterus can lift the abdominal wall away from the area of. Acute abdomen during pregnancy goran augustin this is the second edition of a wellreceived book that reflects the state of the art in diagnosis and treatment of acute abdominal disorders in the pregnant patient. It offers an update on recommendations, guidelines and scenarios to provide fundamental support for all clinicians who might encounter such cases. Systemic approach is essential for an accurate and early. Acute abdomen during pregnancy goran augustin download. Acute abdomen during pregnancy goran augustin springer. Acute abdomen, as it presents with pregnancy, has many possible causes. Urgent hospital referral is often required, unless a ben.
Introduction acute abdomen is a general term for acute abdominal diseases accompanied primarily by sudden abdominal pain for which a decision to perform emergency surgery must be made in a very short time. A case of acute appendicitis during pregnancy was first reported in the literature by hancock in 1848. Nov 16, 2014 the fallopian tube torsion is a rare cause of acute abdomen and even more rare during pregnancy. The acute abdomen in pregnancy remains a diagnostic dilemma. Magnetic resonance imaging mri has been shown to be useful in the diagnosis. This book will help the reader to recognize, diagnose, and treat most of the acute abdominal disorders that may be encountered in the pregnant patient, whether associated with or incidental to the pregnancy. Non obstetric causes and presentation of acute abdomen among. Pdf nonobstetrical acute abdomen during pregnancy goran. Jul 08, 2018 acute abdominal pain in pregnancy can occur due to obstetric factors as well for reasons that are unrelated to pregnancy. Meckels diverticular perforation presenting as acute.
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