scholarly journals Torquálódott méhfüggelék laparoszkópos ellátása a 32. terhességi héten

2021 ◽  
Vol 162 (35) ◽  
pp. 1418-1421
Author(s):  
Márió Attila Vincze ◽  
Gábor Németh ◽  
Tibor Novák
Keyword(s):  
Abdominal Pain ◽  
Clinical Symptoms ◽  
Operative Procedure ◽  
Lower Abdominal Pain ◽  
Pregnant Patient ◽  
Adnexal Torsion ◽  
Maternal Complications ◽  
Increased Risk ◽  
The University ◽  
In Pregnancy

Összefoglaló. Terhességben az élettani és anatómiai változások miatt bizonyos patológiás szervi eltérések nem specifikus tünettannal járhatnak. A várandósság alatt fellépő hasi panaszok esetén lényeges felállítani a gyors és pontos diagnózist, a minél korábbi adekvát terápia érdekében. A klinikai tünetek hátterében többek között állhatnak szülészeti betegségek, illetve appendicitis, megnagyobbodott ovariumcysta, nephrolithiasis vagy diverticulitis is. Esetismertetésünkben egy 32 hetes gravida ellátását prezentáljuk, aki jobb alhasi panaszok miatt jelentkezett a Szegedi Tudományegyetem Szülészeti és Nőgyógyászati Klinikáján. A magzati paraméterek megfelelőek voltak. A klinikai vizsgálatok appendicitis gyanúját vetették fel, mely miatt laparoszkópia történt. Torquálódott jobb oldali tuba uterina miatt jobb oldali salpingectomiát végeztünk, az appendix kóros elváltozása nem igazolódott. Magzati, illetve anyai szövődmény a posztoperatív szakban nem volt. A további terhesgondozás során szövődményt nem észleltünk, majd a betöltött 40. terhességi héten hüvelyi úton egészséges újszülött született. A méhfüggelék megcsavarodásának operatív megoldása laparoszkópos úton alkalmazható módszernek tekinthető terhességben is. Az adnexcsavarodás ritka sürgősségi nőgyógyászati kórképnek számít, bár szakirodalmi adatok alapján az adnexum torsiójának rizikója fokozott lehet a terhesség korai szakaszában, kiváltképp asszisztált reprodukciós technikák alkalmazása esetén. Várandósság alatt hirtelen jelentkező alhasi panaszok esetén az anamnesztikus adatok tükrében, a klinikai vizsgálatok során szükséges az adnextorsio lehetőségére is gondolni. Orv Hetil. 2021; 162(35): 1418–1421. Summary. Due to physiological and anatomical changes in pregnancy, certain pathological organ abnormalities may be associated with non-specific symptoms. In the case of abdominal complaints during pregnancy, it is important to make a quick and accurate diagnosis to apply an early adequate therapy. The cause of the clinical symptoms can be obstetrical diseases, appendicitis, large ovarial cyst, rarely nephrolithiasis or diverticulitis. Through our case study, we present the treatment of a 32-week gravida. Examination of the pregnant patient occured at the Department of Obstetrics and Gynecology of the University of Szeged due to right lower abdominal pain. The fetal parameters were satisfactory. We assumed appendicitis, so after proper preparation laparoscopy was performed. Salpingectomy was performed because of torqued right fallopian tube and no pathological changes were detected on the appendix. In the postoperative period, there were no fetal or maternal complications. During further care of pregnancy, there were no complications and a healthy newborn was born by vaginal delivery at the 40th week of gestation. The operative procedure of adnexal rotation by laparoscopy can be considered as an applicable method even in pregnancy. Adnexal torsion is a rare emergency gynecological disease, although literature data suggest an increased risk in early pregnancy, especially in the case of assisted reproductive technology. In the case of sudden abdominal pain during pregnancy, in the light of anamnestic data, it is recommended to consider the possibility of adnexal torsion, too. Orv Hetil. 2021; 162(35): 1418–1421.

scholarly journals Clinico-pathological and etiological evaluation of acute appendicitis and assessment of significance of laboratory and ultrasonography examination as an ancillary aid to clinical diagnosis

2019 ◽  
Vol 6 (6) ◽  
pp. 1954
Author(s):  
Sailendra Nath Paul ◽  
Dilip Kumar Das
Keyword(s):  
Abdominal Pain ◽  
Acute Appendicitis ◽  
Diagnostic Accuracy ◽  
Scoring System ◽  
Clinical Symptoms ◽  
Lower Abdominal Pain ◽  
Complication Rates ◽  
Alvarado Score ◽  
Negative Appendicectomy ◽  
Operative Findings

Background: Timely diagnosis and intervention of acute appendicitis reduces morbidity and mortality associated with the disease condition. The study aimed to evaluate the etiology of acute appendicitis, to analyze the sensitivity of modified Alvarado scoring system and radiology in the diagnosis of acute appendicitis and to correlate the observations of laboratory tests, operative findings with the histopathological report of specimen of appendix.Methods: This was a prospective study done on 100 patients with clinical symptoms of acute right lower abdominal pain suggestive of appendicular origin during the period from February 2015 to January 2016 in the department of surgery thorough clinical assessment, laboratory investigations, ultrasound findings as were done for all patients. After confirming the diagnosis of AA the patients had operative intervention and specimens were sent for histopathological study.Results: Male preponderance was seen in the study. Majority of them belongs to 21 to 30 years age group (50%). Faecolith was the most common etiological factor observed (58%). Abdominal pain (100%) was the most common clinical symptom. Alvarado score had sensitivity of 95.74% and specificity of 66.67% in diagnosing AA. In correlation to histopathological findings, ultrasonography findings showed 100% positive visualization rate in all 71 cases. Elevated ESR (94%) had high diagnostic accuracy as confirmed by HPE finding (96.81%) which is statistically significant (p<0.000).Conclusions: Alvarado scoring system, elevated ESR levels and USG findings of the appendix can be considered as adjuncts to clinically diagnose the AA, to improve the diagnostic accuracy thereby consequently the rate of negative appendicectomy can be reduced and thus decreases the complication rates.

The Pregnant Surgical Patient

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.

Factors Associated With Operatively Confirmed Adnexal Torsion Among Pregnant Women – A Multicenter Cohort Study

2020 ◽  
Author(s):  
Misgav Rottenstreich ◽  
Ido Moran ◽  
Ayala Hirsch ◽  
Reut Rotem ◽  
Shunit Armon ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Pregnant Women ◽  
Clinical Laboratory ◽  
Multivariate Logistic Regression Analysis ◽  
Lower Abdominal Pain ◽  
Adnexal Torsion ◽  
Multicenter Cohort Study ◽  
Duration Of Symptoms ◽  
Ultrasound Findings ◽  
Previous Cesarean

Abstract Purpose The aim of this study was to investigate the association of clinical, laboratory, and ultrasound findings with the surgical diagnosis of adnexal torsion in a retrospective cohort of women operated for suspected torsion during pregnancy. Materials and Methods A multicenter retrospective study of pregnant women who underwent urgent laparoscopy for suspected adnexal torsion during 2004–2019 in three tertiary medical centers. Results Adnexal torsion was found in 143/208 (68.8 %) cases. Women with adnexal torsion had lower parity and lower rates of previous cesarean section, but higher rates of fertility treatments and multiple gestations, and were more likely to report right lower abdominal pain, with shorter duration of symptoms (< 24 hrs) and vomiting but not nausea. Women with adnexal torsion were found to have higher rates of sonographic findings suggestive of ovarian edema, while normal-appearing ovaries on ultrasound were more common in women without torsion. A multivariate logistic regression analysis showed that complaints of right abdominal pain were positively associated with adnexal torsion (aOR [95 % CI] 5.03 (1.45–17.49), while previous cesarean delivery and ultrasound findings of normal-appearing ovaries were negatively associated with adnexal torsion (aOR of 0.17 (0.05–0.52) and 0.10 (0.02–0.43), respectively). Conclusion Clinical characteristics and ultrasound findings may be incorporated into the emergency room workup of pregnant women with suspected adnexal torsion.

Spontaneous hematoma of the rectus abdominal wall in pregnancy

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.

scholarly journals Management of hemoperitoneum due to rupture of the ovarian cyst

2021 ◽  
Vol 6 (1) ◽  
pp. 6-10
Author(s):  
Oana Denisa Balalau ◽  
Ileana Maria Conea ◽  
Nicolae Bacalbasa ◽  
Anca Silvia Dumitriu ◽  
Stana Paunica ◽  
...  
Keyword(s):  
Abdominal Pain ◽  
Ovarian Cyst ◽  
Lower Abdominal Pain ◽  
Physical Exertion ◽  
Sudden Onset ◽  
Reproductive Age ◽  
Adnexal Torsion ◽  
Ultrasound Monitoring ◽  
Chemical Peritonitis ◽  
Rule Out

Ovarian cyst is the most common female gynecological pathology and it is characteristic of reproductive age. Its rupture causes the sudden onset of pelvic-abdominal pain, often associated with physical exertion or sexual contact. The differential diagnosis is made with other causes of lower abdominal pain: ectopic pregnancy, adnexal torsion, pelvic inflammatory disease or acute appendicitis. The clinical picture may vary depending on the type of ruptured cyst. Dermoid cyst causes severe symptoms due to chemical peritonitis that occurs in response to extravasation of sebaceous contents in the peritoneal cavity. Surgical treatment is indicated for complicated forms of cystic rupture. Most cases have self-limiting, quantitatively reduced bleeding and spontaneous resorption within a few days. Patients diagnosed with ovarian cyst are recommended for regular ultrasound monitoring to prevent complications such as cystic rupture or adnexal torsion. The identification of any ovarian tumor mass in the woman at menopause requires further investigation to rule out the causes of malignancy.

scholarly journals A rare case of ovarian torsion in a pregnant patient

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.

scholarly journals MON-LB64 Primary Hyperparathyroidism With Severe Hypercalcemia During Pregnancy: A Challenging Diagnosis and Management

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Gemy M George ◽  
Rachel L Slotcavage ◽  
Elena Ambrogini
Keyword(s):  
Kidney Stones ◽  
Calcium Absorption ◽  
Second Trimester ◽  
Third Trimester ◽  
Maternal Complications ◽  
Diagnosis And Management ◽  
Dihydroxyvitamin D ◽  
Severe Hypercalcemia ◽  
Increased Risk ◽  
In Pregnancy

Abstract Background:Primary Hyperparathyroidism (PHPT) is rare in pregnancy and the physiological adaptations in mineral and skeletal homeostasis that occur during gestation need to be taken into consideration for the diagnosis and management. Clinical case:A 30-year-old primgravid woman with history of kidney stones presented at our institution during the 13th week of twin gestation with severe nausea and vomiting. She had previously been hospitalized at 9 weeks for hypercalcemia and acute kidney injury, and treated with steroids for presumed granulomatous disease without improvement. She was on prenatal vitamins and family history was significant for kidney stones, but not hypercalcemia. At admission, calcium was 14.4 mg/dl, ionized calcium 1.89 mmol/L (1.16-1.32), PTH 15.2 pg/ml (12-88), albumin 3.4 g/dl, phosphorus 2.1 mg/dl, and creatinine 1.8 mg/dl. PTHrP was &lt;2 pmol/L (&lt;4.2) and 1, 25-dihydroxyvitamin D was 191 pg/mL (2nd trimester range 72-160 pg/ml). She was treated with IV hydration, but her calcium remained elevated and severe hypercalcemia recurred after stopping hydration. She underwent neck exploration and right upper parathyroidectomy in the second trimester. The other parathyroid glands were noted to be normal. Intraoperative PTH dropped from 25.2 pg/mL to 4.4 pg/mL. Final pathology showed a hypercellular parathyroid. Her calcium dropped to normal levels in the early postoperative period. Calcitonin was initiated by another provider two weeks postoperatively for persistent mild hypercalcemia. Her calcium levels remained at the upper limit of normal during her 2nd and 3rd trimesters. PTH remained suppressed at 3.2 pg/ml. She had a C-section at 34 weeks for premature rupture of membranes. Her twins did not develop hypocalcemia or hypoparathyroidism. The most recent postpartum calcium was 9.2 mg/dl with PTH 3.3 pg/ml.Conclusions:Our case highlights the challenge in the diagnosis and management of PHPT in pregnancy. During pregnancy, PHPT is diagnosed by elevated ionized or albumin corrected calcium and non-suppressed PTH level. It is important to note that 1,25-dihydroxyvitamin D levels physiologically increase in the second and third trimester. Since both PHPT and pregnancy cause intestinal calcium absorption and bone resorption, PHPT during pregnancy has increased risk of severe hypercalcemia, pancreatitis and renal stones. During the third trimester the transfer of calcium through the placenta and the uptake of calcium by the fetal skeleton can protect against severe hypercalcemia. However, hypercalcemic crisis can occur because of the peak release of PTHrP by the placenta and breasts, or after delivery due to loss of calcium transfer to the placenta. Parathyroidectomy is preferably performed in the second trimester to reduce fetal and maternal complications. After delivery neonatal hypocalcemia can have a delayed onset, a prolonged course and could be permanent.

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

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.

scholarly journals Spontaneous Bilateral Adrenal Hemorrhage in Pregnancy

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A158-A158
Author(s):  
Nami Safai Haeri ◽  
Jagdeesh Ullal ◽  
Hussain Mahmud
Keyword(s):  
Abdominal Pain ◽  
Adrenal Hemorrhage ◽  
Intrauterine Fetal Death ◽  
New Right ◽  
Adrenal Crisis ◽  
Close Monitoring ◽  
Ct Angiogram ◽  
Increased Risk ◽  
History Of ◽  
In Pregnancy

Abstract Introduction: Spontaneous Adrenal Hemorrhage (SAH) in pregnancy is a rare occurrence with estimated prevalence of 0.03% to 1.8%. SAH usually involves the right gland and can be easily mistaken with other conditions due to its nonspecific symptoms. We hereby report 2 cases of spontaneous bilateral SAH that occurred during the 3rd trimester of pregnancy. Case 1: 28-year-old female with history of IBS presented during 35th week of her first pregnancy with right-sided abdominal pain. Abdominal MRI revealed a 4.7 x 2.8 cm right adrenal hemorrhage. Due to stability of her vitals, steroids were not initiated and she was discharged. She returned 4 days later with similar pain but this time on the left side. MRI did not reveal adrenal bleeding. Due to Blood Pressure (BP) of 90/70 mmHg, hydrocortisone IV 50mg every 8 hours was started. 36 hour later she became tachycardic and tachypneic. CT angiogram (CTa) ruled out Pulmonary Emboli (PE), but was remarkable for interval development of a 5.3 x 3 cm left adrenal hemorrhage. There were no findings indicative of Primary Adrenal Insufficiency (PAI). Patient was discharged home on physiologic dose of hydrocortisone and delivered a healthy baby 2 weeks later at term. Case 2: 30-year-old female with history of hypertension and polycystic kidney disease presented at 31st week of her 2nd pregnancy with left-sided abdominal pain. Abdominal CT scan showed a 2.3 x 3.1 cm left adrenal hemorrhage. Due to BP of 85/50 mmHg at presentation, she was started on hydrocortisone IV 50 mg one dose followed by 25 mg every 8 hours, which improved her BP. 3 days later she developed new right flank pain. MRI was remarkable for features indicative of adrenal hyperplasia but did not confirm presence of hemorrhage. 1 day later she developed hypoxia and underwent CTa to rule out PE, which was remarkable for a new right adrenal hemorrhage. She did not have findings indicative of PAI and was discharged home on physiologic dose of hydrocortisone. Unfortunately, the pregnancy resulted in intrauterine fetal death at 36 weeks. Discussion: Adrenal cortex hyperplasia secondary to physiological elevation of ACTH plus adrenal venous constriction due to increased catecholamine release, have been suggested as possible mechanisms for increased risk of SAH in pregnancy. Common manifestations of SAH include abdominal pain, fever, fatigue, dizziness, anemia and hypotension. Features of PAI such as hyponatremia and hyperkalemia should be expected in cases of over 90% damage of adrenal cortices. Management in pregnancy involves fluid resuscitation, close monitoring for findings suggestive of adrenal crisis, fetal monitoring and glucocorticoid +/- mineralocorticoid replacement if indicated. Possibility for development of bilateral SAH should always be considered in patients who develop unilateral SAH. If left unrecognized, SAH is associated with poor outcomes and high fatality rate for both mother and fetus.

scholarly journals Spectrum of epithelial abnormalities on papanicolaou smear in postmenopausal women

2021 ◽  
Vol 6 (2) ◽  
pp. 97-102
Author(s):  
Sonu Bansal ◽  
Chandrakanta ◽  
Harendra Kumar ◽  
Urvashi Verma
Keyword(s):  
Abdominal Pain ◽  
Postmenopausal Women ◽  
Coming Out ◽  
Gold Standard ◽  
Pap Smear ◽  
Clinical Symptoms ◽  
Lower Abdominal Pain ◽  
Premalignant Lesions ◽  
Normal Cytology ◽  
Bethesda System

The Papanicolaou (Pap) smear was introduced in 1941, became the standard screening test for cervical cancer and premalignant lesions, and is being used globally. To estimate the frequency of various epithelial abnormalities on Pap smear in postmenopausal women and assess their relation with parity, clinical symptoms and per speculum findings. Prospective Pap procedure was done on 400 postmenopausal women from November 2017 to June 2019 and smears were stained and cytological interpretation was made according to the 2014 Bethesda system.Out of 97.5% satisfactory smears, 17.9%, 26.2% and 55.9% were diagnosed as of epithelial abnormalities, normal cytology and inflammatory and other benign conditions respectively. ASCUS-mean age was 45.18 years and parity of 3. Patients were either asymptomatic or presented with white discharge. Incidence among epithelial abnormalities was 31.5% with overall incidence of 5.6%. LSIL- mean age was 48.11 years and parity of 4 and presented with white discharge and lower abdominal pain. Incidence was 37.2% among epithelial abnormalities with overall incidence of 6.7%. HSIL- mean age was 58.78 years with parity of &#62;/=5, presented with white discharge and lower abdominal pain. Incidence among epithelial abnormalities was 27% with overall incidence of 4.8%. SCC -mean age was 58.6 years and parity of &#62;/=5, presented with white discharge, postmenopausal bleed and something coming out of p/v. Incidence was 4.2% among epithelial abnormalities with overall incidence of 0.8%. Pap smear is a simple, cheap, safe and gold standard diagnostic tool for screening postmenopausal women.

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