S3017 Midgut Volvulus in a Pregnant Patient Presenting With Abdominal Pain

A 33-year-old, 8 weeks pregnant, presented with severe upper abdominal pain with vomiting on a background of a previous laparoscopic Nissen fundoplication for reflux disease. An urgent MRI had shown herniation of the fundoplication wrap through the diaphragmatic hiatus. The cause of her symptoms was attributed to hyperemesis gravidarum. The plan was to manage this patient conservatively until the conclusion of her pregnancy. This plan was revised when she presented for the second time and developed worsening pain and haematemesis. An emergency gastroscopy showed ischaemic changes in most of the stomach requiring the patient to undergo an emergency laparotomy. In pregnant patients, presenting with abdominal pain, vomiting as well as haematemesis, having had previous antireflux surgery, incarceration of the stomach must be considered as a differential. Prompt assessment and early senior decision-making is extremely important in avoiding a potentially catastrophic outcome for such patients.

Download Full-text

Pediatric Abdominal Emergencies

10.2310/fm.4404 ◽

2019 ◽

Author(s):

Jeffrey Bullard-Berent ◽

Aaron Kornblith

Keyword(s):

Abdominal Pain ◽

Pyloric Stenosis ◽

Correct Diagnosis ◽

Hypertrophic Pyloric Stenosis ◽

Emergency Department Visits ◽

Infantile Hypertrophic Pyloric Stenosis ◽

Midgut Volvulus ◽

Meckel Diverticulum ◽

Incarcerated Inguinal Hernia ◽

Abdominal Emergencies

Pediatric abdominal emergencies represent a diverse group of conditions affecting children of all ages and are a common cause of emergency department visits. The challenge for emergency physicians is discerning which child presenting with the common complaints of abdominal pain, nausea, vomiting, and diarrhea has an abdominal emergency. The emergency physician must use a thorough history, developmentally appropriate examination skills, and integration of his or her knowledge base to arrive at the correct diagnosis. This review evaluates the most common pediatric abdominal emergencies organized by chronicity from birth to adolescents: midgut volvulus, infantile hypertrophic pyloric stenosis, incarcerated inguinal hernia, ileocecal intussusception, Meckel diverticulum, and appendicitis. Readers will understand common presentations as well as the evaluation and treatment options for each diagnosis. This review contains 7 figures, 9 tables and 64 references Key words: abdominal pain, appendicitis, hernia, hypertrophic pyloric stenosis, intussusception, Meckel diverticulum, midgut volvulus

Download Full-text

The Pregnant Surgical Patient

10.2310/surg.2177 ◽

2015 ◽

Author(s):

Nina Tamirisa ◽

Sami Kilic ◽

Mostafa Borahay

Keyword(s):

Critical Care ◽

Abdominal Pain ◽

Imaging Modality ◽

Pregnant Patient ◽

Surgical Patient ◽

Changes In Pregnancy ◽

Surgical Conditions ◽

Laboratory Changes ◽

In Pregnancy

The most vulnerable time for a fetus is during embryogenesis in the first 8 to 10 weeks of pregnancy, when women may be unaware of their pregnancy. Once pregnancy is established, a standard approach to the pregnant patient is the optimal way to ensure medical and surgical decisions are made within the context of maintaining the safety of both mother and fetus. This review describes the approach to the pregnant patient for surgical conditions within the context of physiologic changes of the patient and fetus at each trimester, anesthesia and critical care in pregnancy, imaging and drugs safe for use in pregnancy, and nongynecologic surgery in the pregnant patient and specific surgical conditions. Tables outline the classification of abortion, the assessment of pregnancy viability, physiologic changes in pregnancy, laboratory changes in pregnancy, imaging modality and radiation dose, and antibiotics and safety in pregnancy. Figures include a diagram of types of hysterectomy, respiratory changes in pregnancy, and enlargement of the uterus. Algorithms outline the approach to abdominal pain in the pregnant patient and diagnosis and management of ectopic pregnancy. This review contains 5 figures, 6 tables, and 85 references.

Download Full-text

Pregnant patient with acute abdominal pain and previous bariatric surgery

BMJ Case Reports ◽

10.1136/bcr-2018-228962 ◽

2019 ◽

Vol 12 (8) ◽

pp. e228962 ◽

Cited By ~ 4

Author(s):

Wouter KG Leclercq ◽

Martine Uittenbogaart ◽

Hendrik J Niemarkt ◽

Judith OEH van Laar

Keyword(s):

Bariatric Surgery ◽

Abdominal Pain ◽

Gestational Age ◽

Acute Abdominal Pain ◽

Gastric Bypass Surgery ◽

Pregnant Patient ◽

Internal Herniation ◽

Diffuse Abdominal Pain ◽

Imaging Patient

Pregnant women who previously had bariatric surgery may develop acute abdominal pain during pregnancy. Two patients, 38-year-old twin primigravida (gestational age of 24+6 weeks) and a 26-year-old woman (gestational age of 24+0 weeks), both of whom had laparoscopic gastric bypass surgery previously, developed abdominal pain. The patients both had diffuse abdominal pain in combination with normal blood tests and imaging. Patient B had undergone laparoscopy at another centre after 5 weeks of gestation for internal herniation. After referral to our multidisciplinary bariatric–obstetric–neonatal (MD-BON) team, diagnostic laparoscopy was advised as internal herniation was deemed possible. In both patients, internal herniation was indeed found in Petersen’s space and jejunal mesenteric defect, which was closed using laparoscopic surgery. Both women delivered healthy offspring afterwards. The presence of an MD-BON team allows for an increased awareness of potential long-term complications associated with earlier bariatric surgery in pregnancy.

Download Full-text

Spontaneous hematoma of the rectus abdominal wall in pregnancy

Case Reports in Perinatal Medicine ◽

10.1515/crpm-2012-0045 ◽

2013 ◽

Vol 2 (1-2) ◽

Author(s):

Mihaela Grigore ◽

Camelia Cojocaru ◽

Alina Mares

Keyword(s):

Abdominal Pain ◽

Abdominal Wall ◽

Ovarian Tumor ◽

Rectus Sheath ◽

Pregnant Patient ◽

Rare Entity ◽

Resonance Imaging ◽

Rectus Sheath Hematoma ◽

Spontaneous Hematoma ◽

In Pregnancy

AbstractRectus sheath hematoma is an uncommon and often clinically misdiagnosed cause of abdominal pain. We report such a case of a 42-year-old woman who developed an abdominal-wall hematoma at 32 weeks of gestation. Initially, she was suspected as having a complicated ovarian tumor associated with pregnancy, because of the intense abdominal pain. Both ultrasound and magnetic resonance imaging proved to be useful in diagnosing rectus sheath hematoma. A conservative management was applied for the rectus sheath hematoma and the patient recovered uneventfully. Although it is a very rare entity, rectus sheath hematoma should be included in the differential diagnosis of every pregnant patient who presents with abdominal pain.

Download Full-text

Intussusception in a pregnant woman

Journal of Surgical Case Reports ◽

10.1093/jscr/rjaa554 ◽

2020 ◽

Vol 2020 (12) ◽

Author(s):

Ana Cristina Silva ◽

Pedro Soares Moreira ◽

Vitor Costa Simões ◽

Mónica Sampaio ◽

Marisa Domingues Santos

Keyword(s):

Emergency Department ◽

Abdominal Pain ◽

Pregnant Woman ◽

Pregnant Patient ◽

Computed Tomography Scan ◽

Intestinal Necrosis ◽

History Of ◽

Emergent Laparotomy ◽

Tomography Scan

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.

Download Full-text

A rare case of ovarian torsion in a pregnant patient

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20215114 ◽

2021 ◽

Vol 11 (1) ◽

pp. 255

Author(s):

Swati Kumari

Keyword(s):

Abdominal Pain ◽

Acute Abdominal Pain ◽

Diagnostic Delay ◽

Pregnant Patient ◽

Ovarian Torsion ◽

Adnexal Torsion ◽

Venous Flow ◽

Presenting Symptoms ◽

Prompt Treatment ◽

Gynecologic Emergency

Torsion of the ovary is the total or partial rotation of the adnexa around its vascular axis or pedicle. It is an uncommon cause of acute abdominal pain in females, and it is a gynecologic emergency. The majority of the cases present in the pregnant (22.7%) than in non-pregnant (6.1%) women. Diagnostic delay can result in loss of the ovary. This twisting initially obstructs venous flow, which causes engorgement and edema. The engorgement can progress until arterial flow is also compromised, leading to ischemia and infarction. The increased use of ovarian stimulation and assisted reproductive technology has led to an increase in the risk of adnexal torsion, particularly in pregnant women or women with ovarian hyperstimulation syndrome (OHSS). The differential diagnosis of adnexal torsion is particularly difficult in combination with OHSS or pregnancy, as abdominal pain, nausea and vomiting can be presenting symptoms of hyperstimulation or pregnancy as well. Here, we report a case of ovarian torsion occurring in pregnancy in which diagnostic delay occurred due to confusion with OHSS leading to oophorectomy. Fertility conservation may have been possible in case of earlier diagnosis and prompt treatment.

Download Full-text

Acute gangrenous appendicitis and acute gangrenous cholecystitis in a pregnant patient, a difficult diagnosis: a case report

International Surgery Journal ◽

10.18203/2349-2902.isj20211831 ◽

2021 ◽

Vol 8 (5) ◽

pp. 1575

Author(s):

David Lew ◽

Jane Tian ◽

Martine A. Louis ◽

Darshak Shah

Keyword(s):

Abdominal Pain ◽

Case Report ◽

General Population ◽

Acute Appendicitis ◽

Acute Cholecystitis ◽

Pregnant Patient ◽

Anatomical Changes ◽

Difficult Diagnosis ◽

Common Complaint ◽

In Pregnancy

Abdominal pain is a common complaint in pregnancy, especially given the physiological and anatomical changes that occur as the pregnancy progresses. The diagnosis and treatment of common surgical pathologies can therefore be difficult and limited by the special considerations for the fetus. While uncommon in the general population, concurrent or subsequent disease processes should be considered in the pregnant patient. We present the case of a 36 year old, 13 weeks pregnant female who presented with both acute appendicitis and acute cholecystitis.

Download Full-text

Left flank pain during pregnancy with an unpredictable etiology: think of nonhemorrhagic adrenal infarction

Future Science OA ◽

10.2144/fsoa-2021-0022 ◽

2021 ◽

pp. FSO718

Author(s):

Myriam Jerbaka ◽

Tracy Slaiby ◽

Zahraa Farhat ◽

Yara Diab ◽

Nawal Toufayli ◽

...

Keyword(s):

Computed Tomography ◽

Abdominal Pain ◽

Pregnant Woman ◽

Pregnant Patient ◽

Flank Pain ◽

Computed Tomography Scan ◽

Left Flank ◽

Left Flank Pain ◽

Tomography Scan ◽

Adrenal Infarction

Abdominal pain is the most presenting complaint during pregnancy with multiple etiologies. The diagnosis could be unpredictable. We present a case of 36-year-old pregnant woman gravida 10 para 7 abortus 2 at 36 + 5 weeks of gestation presenting twice for an increasing left abdominal pain, not relieved despite analgesics. She was delivered for severe oligohydramnios. After delivery, she was found to have a left adrenal infarction on computed tomography scan. She was found to have two mutations of the gene MTHFR 677CC. Our presented case should remind physicians to consider the presence of thromboembolic state during pregnancy. The diagnosis of adrenal infarction should be among the differentials of an ambiguous flank pain that is resilient to medical therapy. Diagnosis in a pregnant patient can be easily confirmed with MRI, after which anticoagulation should be started and the workup for hypercoagulable state investigated.

Download Full-text

Management of ureteric stones in pregnancy

10.1093/med/9780199659579.003.0029 ◽

2017 ◽

Author(s):

Ben Turney ◽

John Reynard

Keyword(s):

Abdominal Pain ◽

Renal Colic ◽

Treatment Options ◽

Pregnant Patient ◽

Stone Extraction ◽

Surgical Technology ◽

Recommended Treatment ◽

Potential Problems ◽

Primary Management ◽

In Pregnancy

Renal colic is the most common non-obstetric cause for abdominal pain and hospitalization during pregnancy. Ureteric stones occur in about 1 in 2,000 pregnancies, most (>80%) in the second and third trimesters. Primary management concerns are diagnostic foetal radiation exposure and the potential for adverse perinatal events arising either from the stone or from intervention. Indications for intervention are the same as for the non-pregnant patient, but are influenced by obstetric circumstances. Active treatment options may be temporizing (stent or nephrostomy) or definitive (ureteroscopic stone extraction). Historically, temporizing measures were the only recommended treatment option. However, potential problems associated with temporary drainage mechanisms include recurrent obstruction, infection, nephrostomy displacement, encrustation, infection, and pain. These factors may impact on pregnancy. In recent years, advances in surgical technology and technique have permitted definitive ureteroscopic management of stones during pregnancy.

Download Full-text