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Ayyash M, Miller M, Smith N, Espy J, Kim SK. Management of small bowel obstruction in the third trimester. BMJ Case Rep 2024; 17:e255843. [PMID: 38442967 PMCID: PMC10916100 DOI: 10.1136/bcr-2023-255843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2024] Open
Abstract
Small bowel obstruction (SBO) in pregnancy is exceedingly rare. Management of SBO in the third trimester may pose particular challenges, as clinicians must determine whether or not the delivery of the fetus is indicated. In this report, we review the case of a patient in her mid-20's with no prior surgical history who presented with nausea and vomiting at 34 weeks of gestation and was ultimately diagnosed with an SBO. Following expectant management during the initial 4 days of inpatient admission, the patient subsequently underwent an exploratory laparotomy at 35 weeks without concurrent delivery. She was monitored for the remainder of her pregnancy with non-stress tests to evaluate fetal status and eventually underwent induction of labour at 39 weeks, resulting in a successful vaginal delivery. Herein, we review the challenges related to the diagnosis and management of SBO in pregnancy, as well as the maternal-fetal outcomes in the setting of SBO in the third trimester.
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Affiliation(s)
- Mariam Ayyash
- Department of Women's Health, Obstetrics and Gynecology, Henry Ford Health System, Detroit, Michigan, USA
| | - Madison Miller
- Department of Women's Health, Obstetrics and Gynecology, Henry Ford Health System, Detroit, Michigan, USA
| | - Nicolina Smith
- Department of Women's Health, Division of Maternal Fetal Medicine, Obstetrics and Gynecology, Henry Ford Health System, Detroit, Michigan, USA
| | - Jeannette Espy
- Department of Women's Health, Obstetrics and Gynecology, Henry Ford Health System, Detroit, Michigan, USA
| | - Sun Kwon Kim
- Department of Women's Health, Division of Maternal Fetal Medicine, Obstetrics and Gynecology, Henry Ford Health System, Detroit, Michigan, USA
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Almulhim Z, Othman S, Alarfaj M, Hamadah N, Bamalan O, Alanazi F. A Rare Case of Small Bowel Obstruction in Pregnancy Due to Adenocarcinoma. Cureus 2024; 16:e53124. [PMID: 38288321 PMCID: PMC10822782 DOI: 10.7759/cureus.53124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2024] [Indexed: 01/31/2024] Open
Abstract
Small bowel obstruction (SBO) rarely occurs in pregnancy, primarily due to the adhesions resulting from previous abdominal surgery. However, malignancy causing SBO during pregnancy is exceedingly rare. We present a case of a 34-year-old pregnant woman who was recently diagnosed with small bowel disease at 19 weeks and two days of gestation and initially managed conservatively. Diagnostic procedures, such as endoscopy or colonoscopy and enterography magnetic resonance imaging (MRI), were postponed due to her pregnancy. With recurrent episodes of worsening symptoms, the patient underwent multiple admissions, during which an abdominal X-ray was performed, revealing dilated loops of the small and large bowel, highly suggestive of SBO. Subsequently, a plain abdominal MRI revealed a stricture in the left lower quadrant, resulting in SBO. Given the absence of a fetal pulse, the patient underwent an emergency laparotomy. Surgical resection involving part of the mass in the terminal ileum was performed, followed by a primary side-to-side anastomosis. Histopathological examination of the resected tissue confirmed the presence of small bowel adenocarcinoma. The successful surgical resection and subsequent histopathological confirmation emphasized the importance of prompt diagnosis and appropriate management. This case underscores the challenges faced in diagnosing and managing small bowel obstruction during pregnancy, particularly when malignancy is the underlying cause. It highlights the need to balance diagnostic investigations with fetal safety. Multidisciplinary collaboration between obstetricians, surgeons, and radiologists is crucial in navigating the complexities of managing such cases and ensuring optimal outcomes for both the mother and the fetus.
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Affiliation(s)
- Zainab Almulhim
- Department of Obstetrics and Gynecology, Imam Abdulrahman Bin Faisal University, Dammam, SAU
- Department of Obstetrics and Gynecology, King Fahad University Hospital, Al Khobar, SAU
| | - Sharifah Othman
- Department of Obstetrics and Gynecology, Imam Abdulrahman Bin Faisal University, Dammam, SAU
- Department of Obstetrics and Gynecology, King Fahad University Hospital, Al Khobar, SAU
| | - Mosab Alarfaj
- Department of Surgery, Imam Abdulrahman Bin Faisal University, Dammam, SAU
- Department of Surgery, King Fahad University Hospital, Al Khobar, SAU
| | - Nasreen Hamadah
- Department of Obstetrics and Gynecology, Imam Abdulrahman Bin Faisal University, Dammam, SAU
- Department of Obstetrics and Gynecology, King Fahad University Hospital, Al Khobar, SAU
| | - Omar Bamalan
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
| | - Faris Alanazi
- College of Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
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Shen J, Teng X, Chen J, Jin L, Wang L. Intestinal obstruction in pregnancy-a rare presentation of uterine perforation. BMC Pregnancy Childbirth 2023; 23:507. [PMID: 37434108 DOI: 10.1186/s12884-023-05827-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 07/01/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND Intestinal obstruction is an uncommon non-obstetric condition during pregnancy which may cause maternal and fetal mortality. Clinicians are confronted with challenges in diagnosis and treatment of intestinal obstruction due to the overlapping symptoms, concerns over radiological evaluation, and surgical risks. CASE PRESENTATION We reported a 39-year old, gravida 7, para 2, woman who suffered from acute intestinal obstruction at 34 weeks of gestation. Ultrasonography and abdominal computed tomography were applied for intestinal obstruction diagnose. Conservative treatment was initially attempted. But following ultrasound found the absence of fluid in the amniotic sac and the patient showed no improvement in clinical symptoms. An emergency caesarean section was then performed. Intra-operative assessment showed dense adhesion between the left wall of uterus and omentum, descending colon, and sigmoid colon. After adhesion dialysis, uterine rupture with complete opening of the uterine wall at the site of left uterine cornua was found without active bleeding. The uterine rupture was then repaired. CONCLUSIONS Although uncommon during pregnancy, clinical suspicion of bowel obstruction is necessary especially in women with a history of abdominal surgery. Surgical intervention is indicated when conservative therapy fails and when there are signs of abnormal fetal conditions and worsened symptoms.
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Affiliation(s)
- Jiayu Shen
- Department of Obstetrics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang Province, Hangzhou, China
| | - Xinyuan Teng
- Department of Obstetrics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang Province, Hangzhou, China
| | - Jing Chen
- Department of Obstetrics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang Province, Hangzhou, China
| | - Ligui Jin
- Department of Obstetrics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang Province, Hangzhou, China
| | - Liquan Wang
- Department of Obstetrics, The Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang Province, Hangzhou, China.
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Midgut Volvulus in a Pregnant Patient Presenting With Abdominal Pain. ACG Case Rep J 2023; 10:e00983. [PMID: 36777462 PMCID: PMC9911195 DOI: 10.14309/crj.0000000000000983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 01/09/2023] [Indexed: 02/14/2023] Open
Abstract
Abdominal pain is a common symptom during pregnancy, but bowel obstruction as the cause is a rare phenomenon. Moreover, intestinal volvulus is an even more unusual cause of obstruction during pregnancy and normally involves the sigmoid colon. We report a unique case of midgut volvulus in a pregnant patient entering her third trimester who presented to the hospital with abdominal pain. Our case demonstrates the safety of computed topography in pregnancy while restricting radiation dose and highlights the need to have a high index of suspicion for bowel obstruction when approaching a pregnant patient with abdominal pain.
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5
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Surgery in Pregnancy. Am J Gastroenterol 2022; 117:53-59. [PMID: 36194034 DOI: 10.14309/ajg.0000000000001961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 06/23/2022] [Indexed: 12/11/2022]
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A Case of a Patient with Adhesive Small Bowel Obstruction in Pregnancy after Extensive Myomectomy for Diffuse Uterine Leiomyomatosis. Case Rep Obstet Gynecol 2022; 2022:3601945. [PMID: 36199388 PMCID: PMC9529410 DOI: 10.1155/2022/3601945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 09/15/2022] [Indexed: 11/17/2022] Open
Abstract
Background. Diffuse uterine leiomyomatosis is a rare disease in which countless, poorly defined, and small nodules are present in most parts of the uterine myometrium. It frequently occurs in fertile women and causes infertility. A deep, median, longitudinal incision of the uterine corpus with the opening of the endometrial cavity, “extensive myomectomy,” is required to restore fertility. However, myomectomy may also be a risk factor for perinatal complications. We present a rare case of adhesive small bowel obstruction after extensive myomectomy for diffuse uterine leiomyomatosis. Case. A 37-year-old primigravida presented with sharp epigastric pain and vomiting at 21-week gestation. The patient had a history of extensive myomectomy for diffuse uterine leiomyomatosis. Abdominal radiography revealed moderate air fluid levels in the small intestine, and the patient was diagnosed with adhesive small bowel obstruction. The patient was also diagnosed with placenta previa. Bowel rest with intestinal tube was continued until delivery. Cesarean section was performed at 32-week gestation due to (i) prolonged fasting and total parenteral nutrition for conservative treatment and (ii) fear of sudden massive bleeding from placenta previa. Because the ileum was strongly adherent to the uterine scar from the previous myomectomy, adhesiolysis and enterectomy were performed. The placenta was uncomplicatedly delivered and the hemorrhage was well-controlled. Conclusions. Pregnancy with a history with extensive myomectomy for diffuse uterine leiomyomatosis should be carefully monitored because of the occasional occurrence of adhesive small intestine obstruction during pregnancy.
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Kundu R, Srinivasan S. Parturient with Acute Abdomen. Indian J Crit Care Med 2022; 25:S223-S229. [PMID: 35615606 PMCID: PMC9108781 DOI: 10.5005/jp-journals-10071-24013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Management of a parturient with an acute abdomen presents unique challenges. We aim to review the common obstetric and nonobstetric causes for acute abdomen in pregnancy, approach to diagnosis, the role of imaging, and management including the scope and timing of operative intervention.
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Affiliation(s)
- Riddhi Kundu
- Department of Critical Care Medicine, Manipal Hospital, New Delhi, India
| | - Shrikanth Srinivasan
- Department of Critical Care Medicine, Manipal Hospital, New Delhi, India
- Shrikanth Srinivasan, Department of Critical Care Medicine, Manipal Hospital, New Delhi, India, Phone: +91 9560300723, e-mail:
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Wei L, Zhang Y, Song X. Strangulated internal hernia following severe ovarian hyperstimulation syndrome: a case report. Gynecol Endocrinol 2021; 37:93-96. [PMID: 33078979 DOI: 10.1080/09513590.2020.1812568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Ovarian hyperstimulation syndrome (OHSS) is a serious complication of ovarian stimulation. Herein, we report a rare case of strangulated internal hernia in a woman with severe OHSS following ovulation induction. A delay in the diagnosis and management of acute abdominal pain can lead to serious problems. The aim of this case report was to highlight the diagnostic difficulties of abdominal pain in women with OHSS, and emphasize the positive effects of imaging and a timely differential diagnosis in clinical practice.
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Affiliation(s)
- Likun Wei
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China
| | - Yanfang Zhang
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China
| | - Xueru Song
- Department of Gynecology and Obstetrics, Tianjin Medical University General Hospital, Tianjin, China
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9
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Silva AC, Moreira PS, Simões VC, Sampaio M, Santos MD. Intussusception in a pregnant woman. J Surg Case Rep 2020; 2020:rjaa554. [PMID: 33425324 PMCID: PMC7778518 DOI: 10.1093/jscr/rjaa554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/26/2020] [Accepted: 12/02/2020] [Indexed: 11/14/2022] Open
Abstract
Abdominal pain in a pregnant woman with a history of laparoscopic Roux-en-Y gastric bypass (LRYGB) in the emergency department is challenging. Intussusception is a rare cause of small bowel obstruction after LRYGB and can lead to intestinal necrosis, perforation, sepsis and death. The authors report a case of a 34-week pregnant patient, previously submitted to LRYGB, presenting to the emergency department with abdominal pain and vomiting. A computed tomography scan suggested the presence of ileoileal intussusception. So, an emergent laparotomy was performed with invagination reduction. The postoperative period was uneventful, as well as pregnancy and caesarian performed 4 weeks after surgery. At the 45-month follow-up, there was no recurrence of intussusception.
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Affiliation(s)
- Ana Cristina Silva
- Colorectal Unit, Surgery Department, Centro Hospitalar do Porto, Hospital de Santo António, 4099-001, Porto, Portugal
| | - Pedro Soares Moreira
- Colorectal Unit, Surgery Department, Centro Hospitalar do Porto, Hospital de Santo António, 4099-001, Porto, Portugal
| | - Vitor Costa Simões
- Colorectal Unit, Surgery Department, Centro Hospitalar do Porto, Hospital de Santo António, 4099-001, Porto, Portugal
| | - Mónica Sampaio
- Colorectal Unit, Surgery Department, Centro Hospitalar do Porto, Hospital de Santo António, 4099-001, Porto, Portugal
| | - Marisa Domingues Santos
- Colorectal Unit, Surgery Department, Centro Hospitalar do Porto, Hospital de Santo António, 4099-001, Porto, Portugal
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10
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Bridwell RE, Carius BM, Long B, Oliver JJ, Schmitz G. Sepsis in Pregnancy: Recognition and Resuscitation. West J Emerg Med 2019; 20:822-832. [PMID: 31539341 PMCID: PMC6754194 DOI: 10.5811/westjem.2019.6.43369] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 05/23/2019] [Accepted: 06/16/2019] [Indexed: 12/29/2022] Open
Abstract
The normal physiologic changes of pregnancy complicate evaluation for sepsis and subsequent management. Previous sepsis studies have specifically excluded pregnant patients. This narrative review evaluates the presentation, scoring systems for risk stratification, diagnosis, and management of sepsis in pregnancy. Sepsis is potentially fatal, but literature for the evaluation and treatment of this condition in pregnancy is scarce. While the definition and considerations of sepsis have changed with large, randomized controlled trials, pregnancy has consistently been among the exclusion criteria. The two pregnancy-specific sepsis scoring systems, the modified obstetric early warning scoring system (MOEWS) and Sepsis in Obstetrics Score (SOS), present a number of limitations for application in the emergency department (ED) setting. Methods of generation and subsequently limited validation leave significant gaps in identification of septic pregnant patients. Management requires consideration of a variety of sources in the septic pregnant patient. The underlying physiologic nature of pregnancy also highlights the need to individualize resuscitation and critical care efforts in this unique patient population. Pregnant septic patients require specific considerations and treatment goals to provide optimal care for this particular population. Guidelines and scoring systems currently exist, but further studies are required.
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Affiliation(s)
- Rachel E Bridwell
- Brooke Army Medical Center, Department of Emergency Medicine, Fort Sam Houston, Texas
| | - Brandon M Carius
- Brooke Army Medical Center, Department of Emergency Medicine, Fort Sam Houston, Texas
| | - Brit Long
- Brooke Army Medical Center, Department of Emergency Medicine, Fort Sam Houston, Texas
| | - Joshua J Oliver
- Brooke Army Medical Center, Department of Emergency Medicine, Fort Sam Houston, Texas
| | - Gillian Schmitz
- Brooke Army Medical Center, Department of Emergency Medicine, Fort Sam Houston, Texas
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Abstract
Appendectomy for presumed appendicitis is the most common surgical emergency during pregnancy. Delayed diagnosis and treatment of appendicitis carries risk for the fetus and mother. We sought to evaluate the accuracy of MRI in pregnant patients with suspected appendicitis. All pregnant patients with suspected appendicitis between January 2014 and April 2016 were included. MRI reports were categorized into positive, negative, and inconclusive groups. Diagnosis of appendicitis was based on pathology report. Fifty-two patients were included in the study. The MRI was positive in two, negative in 29, and inconclusive in 21 patients. Twelve patients had surgery, 11 of which had positive appendicitis on pathology. Both positive MRI patients had appendicitis. In the negative MRI group, 3 of 29 (10%) had appendicitis. In the inconclusive MRI group, 6 of 21 (29%) had appendicitis. A positive MRI result was very specific with a 100 per cent positive predictive value; however, the sensitivity was as low as 18 per cent (diagnosed only 2 of 11 cases). Although a positive MRI finding was reliable in making a decision to operate, a negative or inconclusive MRI was not. In patients with a high clinical suspicion of appendicitis, surgery should still be considered even without definitive positive MRI findings.
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Affiliation(s)
- Fabiola Aguilera
- From the Department of Surgery, Bronx-Lebanon Hospital Center, Bronx, New York
| | - Brian F. Gilchrist
- From the Department of Surgery, Bronx-Lebanon Hospital Center, Bronx, New York
| | - Daniel T. Farkas
- From the Department of Surgery, Bronx-Lebanon Hospital Center, Bronx, New York
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12
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MRI of Acute Abdominal and Pelvic Non-obstetric Conditions in Pregnancy. CURRENT RADIOLOGY REPORTS 2018. [DOI: 10.1007/s40134-018-0285-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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13
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Abu-Zidan FM, Abdel-Kader S, Abusharia MI, Mousa H. Role of magnetic resonance imaging in the management of intestinal obstruction during the first trimester of pregnancy. ANZ J Surg 2016; 88:E683-E684. [PMID: 27246962 DOI: 10.1111/ans.13655] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 04/07/2016] [Accepted: 05/11/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Fikri M Abu-Zidan
- Department of Surgery, College of Medicine and Health Sciences, UAE University, Al-Ain, UAE
| | | | | | - Hussam Mousa
- Department of Surgery, Al-Ain Hospital, Al-Ain, UAE
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14
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Franca Neto AHD, Amorim MMRD, Nóbrega BMSV. Acute appendicitis in pregnancy: literature review. Rev Assoc Med Bras (1992) 2016; 61:170-7. [PMID: 26107368 DOI: 10.1590/1806-9282.61.02.170] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2014] [Accepted: 07/03/2014] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION suspected appendicitis is the most common indication for surgery in non-obstetric conditions during pregnancy and occurs in about one in 500 to one in 635 pregnancies per year. This occurs more often in the second trimester of pregnancy. Acute appendicitis is the most common general surgical problem encountered during pregnancy. METHODS a literature review on research of scientific articles, under the terms "acute appendicitis" and "pregnancy", in PubMed, Lilacs/SciELO, Scopus, Cochrane Library and Uptodate databases. RESULTS the clinical manifestations of appendicitis are similar to non-pregnant women, however, without a classic presentation, which often occurs, diagnosis is difficult and must be supported by imaging. DISCUSSION clinical diagnosis should be strongly suspected in pregnant women with classic findings such as abdominal pain that migrates to the right lower quadrant. The main purpose of imaging is to reduce delays in surgical intervention due to diagnostic uncertainty. A secondary objective is to reduce, but not eliminate, the negative appendectomy rate. Differential diagnosis of suspected acute appendicitis usually includes pathologies considered in non-pregnant people. CONCLUSION the imaging study of choice is ultrasound, MRI may be used when the former is not conclusive and, as a last resort, a CT scan can be performed. The treatment remains appendectomy by laparotomy, since the feasibility of video- assisted surgery in these cases remains controversial.
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15
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Webster PJ, Bailey MA, Wilson J, Burke DA. Small bowel obstruction in pregnancy is a complex surgical problem with a high risk of fetal loss. Ann R Coll Surg Engl 2015; 97:339-44. [PMID: 26264083 DOI: 10.1308/003588415x14181254789844] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Small bowel obstruction (SBO) in pregnancy is rare and is most commonly caused by adhesions from previous abdominal surgery. Previous literature reviews have emphasised the need for prompt laparotomy in all cases of SBO because of the significant risks of fetal loss and maternal mortality. We undertook a review of the contemporary literature to determine the optimum management strategy for SBO in pregnancy. METHODS The MEDLINE® and PubMed databases were searched for cases of SBO in pregnancy between 1992 and 2014. Two cases from our own institution were also reviewed. RESULTS Forty-six cases of SBO in pregnancy were identified, with adhesions being the most common aetiology (50%). The overall risk of fetal loss was 17% and the maternal mortality rate was 2%. In cases of adhesional SBO, 91% of cases were managed surgically, with 14% fetal loss. Two cases (9%) were managed conservatively with no complications. Magnetic resonance imaging (MRI) was used to diagnose SBO in 11% of cases. CONCLUSIONS Based on our experience and the contemporary literature, we recommend that urgent MRI of the abdomen should be undertaken to diagnose the aetiology of SBO in pregnancy. In cases of adhesional SBO, conservative treatment may be safely commenced, with a low threshold for laparotomy. In other causes, such as volvulus or internal hernia, laparotomy remains the treatment of choice.
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Affiliation(s)
| | | | - J Wilson
- Leeds Teaching Hospitals NHS Trust , UK
| | - D A Burke
- Leeds Teaching Hospitals NHS Trust , UK
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16
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Weston P, Moroz P. Appendicitis in pregnancy: how to manage and whether to deliver. ACTA ACUST UNITED AC 2015. [DOI: 10.1111/tog.12188] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Polly Weston
- Joondalup Health Campus; Corner Shenton Ave and Grand Blvd Joondalup Western Australia 6027
| | - Paul Moroz
- University of Western Australia; Joondalup Health Campus; 60 Shenton Ave Joondalup Western Australia 6027
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17
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Intestinal obstruction in pregnancy: a case report. Case Rep Obstet Gynecol 2013; 2013:564838. [PMID: 23476843 PMCID: PMC3580938 DOI: 10.1155/2013/564838] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2012] [Accepted: 01/08/2013] [Indexed: 11/29/2022] Open
Abstract
Background. Intestinal obstruction in pregnancy is uncommon. The condition is associated with significant maternal and fetal mortality. The delay in diagnosis is due to nonspecific symptoms and a disinclination to carry out radiologic investigations in pregnancy. Case. A 39-year-old lady at 32 weeks of gestation presented with abdominal pain and nausea. Her symptoms worsened during admission. A computed tomography (CT) scan showed dilated small bowel loops suggestive of intestinal obstruction. She eventually underwent a laparotomy as conservative measures failed.
Conclusion. A high index of clinical suspicion is required to diagnose intestinal obstruction in pregnancy. Prompt diagnosis should be made and the appropriate treatment instituted. Surgical intervention should be performed if necessary as further delay only results in increased morbidity and mortality.
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Abstract
Acute abdomen is not a disease entity on its own but describes a critical state of the patient which can be caused by numerous diseases. The surgeon and internist have to apply an interdisciplinary approach to enable a rapid decision on whether immediate laparotomy is mandatory. Few appropriate diagnostic procedures support decision making. In many cases there is an indication for immediate surgery, such as perforated gastric or duodenal ulcer, acute appendicitis, diverticulitis, ruptured aortic aneurysm, mechanic ileus, infarction of the mesenteric artery. This review is mainly focused on diseases which may present as acute abdomen but for which surgery is usually not indicated, such as acute pancreatitis. Furthermore, one also has to consider rare diseases in which laparotomy would clearly be a mistake, such as acute intermittent porphyria or intestinal pseudo-obstruction.
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Affiliation(s)
- J Mössner
- Medizinische Klinik und Poliklinik II der Universität Leipzig.
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19
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Hsu CC, Liu YP, Lien WC, Lai TI, Wang HP. A pregnant woman presenting to the ED with Valentino's syndrome. Am J Emerg Med 2005; 23:217-8. [PMID: 15765353 DOI: 10.1016/j.ajem.2004.04.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Chia-Chun Hsu
- Department of Emergency Medicine, National Taiwan University Hospital, College of Medicine, Taipei, Taiwan
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20
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Arora D, Bhattacharyya TK, Kathpalia SK, Kochar S, Lele PR. Acute Abdomen in Gynaecological Practice. Med J Armed Forces India 2005; 61:66-70. [PMID: 27407707 PMCID: PMC4923373 DOI: 10.1016/s0377-1237(05)80124-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2004] [Accepted: 12/15/2004] [Indexed: 10/18/2022] Open
Abstract
Acute abdomen in pregnancy is due to consequence of pregnancy itself or is totally unrelated to pregnancy. During pregnancy, a woman is at an increased risk of acute abdomen due to various physiological changes. The article discusses the various conditions which can present as acute abdomen in women during pregnancy and in non-pregnant state. The clinician often has a difficult task in diagnosing and managing acute abdomen in pregnancy. Clinical evaluation is further confounded by various anatomical and physiological changes occurring in pregnancy. The growing gravid uterus too causes difficulty in detailed examination. The general reluctance to use conventional X-rays because of pregnancy should be set aside when faced with a seriously ill mother. A reluctance to operate during pregnancy adds unnecessary delay, which increases morbidity for both the mother and the fetus. Adnexal accidents should always be kept in mind in a woman with acute abdomen even if she is not pregnant. Such mistakes should be avoided as prompt diagnosis and appropriate therapy are crucial. A general approach to acute abdominal conditions in pregnancy is to manage these problems considering the risk to mother regardless of the pregnancy.
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Affiliation(s)
- Devendra Arora
- Reader, Department of Obstetrics and Gynaecology, Armed Forces Medical College, Pune - 411040
| | - T K Bhattacharyya
- Professor & Head, Department of Obstetrics and Gynaecology, Armed Forces Medical College, Pune - 411040
| | - S K Kathpalia
- Associate Professor, Department of Obstetrics and Gynaecology, Armed Forces Medical College, Pune - 411040
| | - Sps Kochar
- Reader, Department of Obstetrics and Gynaecology, Armed Forces Medical College, Pune - 411040
| | - P R Lele
- Clinical Tutor, Department of Obstetrics and Gynaecology, Armed Forces Medical College, Pune - 411040
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22
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Affiliation(s)
- E K Tan
- Dumfries and Galloway Royal Infirmary, Scotland, UK.
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23
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Abstract
Numerous medical, surgical, psychiatric, gynecologic, and obstetric disorders can cause abdominal pain during pregnancy. The patient history, physical examination, laboratory data, and radiologic findings usually provide the diagnosis. The pregnant woman has physiologic alterations that affect the clinical presentation, including atypical normative laboratory values. Abdominal ultrasound is generally the recommended radiologic imaging modality; roentgenograms are generally contraindicated during pregnancy because of radiation teratogenicity. Concerns about the fetus limit the pharmacotherapy. Maternal and fetal survival have recently increased in many life-threatening conditions, such as ectopic pregnancy, appendicitis, and eclampsia, because of improved diagnostic technology, better maternal and fetal monitoring, improved laparoscopic technology, and earlier therapy.
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Affiliation(s)
- Mitchell S Cappell
- Division of Gastroenterology, Department of Medicine, Woodhull Medical Center, 760 Broadway Avenue, Brooklyn, NY 11206, USA
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Affiliation(s)
- Ian Jones
- Department of Obstetrics and Gynaecology, University of Queensland, Australia
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