scholarly journals Volvulus, gangrene and perforation of transverse colon in an antepartum eclamptic pregnant patient post caesarean: a case report

2020 ◽  
Vol 9 (8) ◽  
pp. 3505
Author(s):  
Jharna Behura ◽  
Sanjiva Kumar ◽  
Poonam Bagga ◽  
Maruti Sinha
Keyword(s):  
Abdominal Pain ◽  
Transverse Colon ◽  
Surgical Complication ◽  
Fetal Distress ◽  
Pregnant Patient ◽  
Middle Part ◽  
High Rate ◽  
Emergency Laparotomy ◽  
Mortality And Morbidity ◽  
In Pregnancy

Transverse colon volvulus leading to gangrene and perforation is an extremely uncommon acute surgical complication in pregnancy and puerperium, with a very high rate of mortality and morbidity. Surgical resection is the only treatment. Authors present a case of a 20 years. old women, with antepartum eclampsia, who underwent caesarean section for fetal distress. She complained of abdominal pain from second post-operative day. The pain increased in severity and on the third postoperative day, she developed sudden abdominal distention and appeared pale. Ultrasound revealed free intraperitoneal fluid suggestive of hemoperitoneum. An emergency laparotomy was performed. There was about a litre of blood in the peritoneal cavity with clots. The caesarean incision site, uterus adnexa and broad ligaments were all intact. On further exploration, volvulus of the transverse colon was seen along with gangrene and perforation of the middle part of transverse colon. Resection of the gangrenous part was done with closure of the distal loop. Proximal loop was brought out as colostomy. The patient had an uneventful postoperative course thereafter and was discharged on regular diet on 12th postoperative day. Volvulus of transverse colon leading to gangrene is rare in pregnancy and puerperium, but must form part of clinician’s differential diagnosis when encountering a patient with persistent abdominal pain and bowel distention. Early diagnosis and timely surgical intervention could significantly improve the outcome of this catastrophic condition.

Unusual case of hyperemesis in a pregnant patient with prior antireflux surgery

2021 ◽  
Vol 14 (8) ◽  
pp. e241935
Author(s):  
Abimbola Obisesan ◽  
Eleanor Lucy Townsend ◽  
John Lin Hieng Wong ◽  
Vinod Menon
Keyword(s):  
Decision Making ◽  
Abdominal Pain ◽  
Antireflux Surgery ◽  
Unusual Case ◽  
Nissen Fundoplication ◽  
Hyperemesis Gravidarum ◽  
Pregnant Patient ◽  
Emergency Laparotomy ◽  
Laparoscopic Nissen ◽  
Upper Abdominal

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.

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.

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 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.

Management of ureteric stones in pregnancy

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.

scholarly journals The recurrence of colonic volvulus due to nonrotation after intestinal resection in adulthood: a case report

2019 ◽  
Vol 5 (1) ◽  
Author(s):  
Yusuke Sakimura ◽  
Hirotaka Kitamura ◽  
Noriyuki Inaki ◽  
Hiroyuki Bando
Keyword(s):  
Abdominal Pain ◽  
Transverse Colon ◽  
Abdominal Cavity ◽  
Intestinal Resection ◽  
Lower Abdominal Pain ◽  
Emergency Laparotomy ◽  
Ascending Colon ◽  
Colonic Volvulus ◽  
Abdominal Symptoms ◽  
Initial Surgery

Abstract Background Intestinal nonrotation is a rare congenital condition that causes fatal colonic volvulus at any age. Once volvulus attack occurs, radical surgical therapy is required for treatment and the prevention of recurrence. This report describes the case of an adult female patient with a recurrence of cecum volvulus due to intestinal nonrotation after transverse colon resection for colonic volvulus. Case presentation A 27-year-old female visited our emergency room (ER) with intermittent abdominal pain and nausea. Enhanced computed tomography (CT) showed enlargement of the level of the ascending and transverse colon and an obstruction with a whirlpool sign at the transverse colon. The small intestine was distributed on the right side of the abdominal cavity, and the large intestine occupied the left side. She was diagnosed with volvulus with intestinal nonrotation, and emergency surgery was performed. Surgical examination indicated that the ascending colon to the transverse colon was not fixed to the retroperitoneum, and the transverse colon was rotated 180° clockwise. The axis of the volvulus was a mesenteric adhesion of the transverse colon. The involved transverse colon was resected, and the intestine was reconstructed by functional end-to-end anastomosis (FEEA). Six years after the initial surgery, the patient presented to the ER with abdominal fullness and lower abdominal pain. Enhanced CT revealed that the cecum, ascending colon, and remaining transverse colon were dilated with an obstruction. The appendix was located in the left upper abdominal cavity. The clinical diagnosis was cecal volvulus with intestinal nonrotation. An emergency laparotomy revealed that the cecum was rotated 180° clockwise. The terminal ileum to the remaining transverse colon was resected, and FEEA was performed. Seven months later, she suffered obstruction of the intestine caused by an operative adhesion, and conservative treatment was successful. The patient has had no abdominal symptoms for one and a half years so far. Conclusions Surgeons should realize that nonrotation of the intestines induces volvulus in adulthood and should familiarize themselves with its clinical findings, appropriate treatment, and prognosis. Even after surgical treatment, awareness of the recurrence of volvulus should be maintained to avoid a late diagnosis.

Sepsis in obstetrics

2016 ◽  
Author(s):  
Nuala Lucas ◽  
Colleen D. Acosta ◽  
Marian Knight
Keyword(s):  
Pregnant Patient ◽  
Physiological Changes ◽  
Risk Of Infection ◽  
Surviving Sepsis Campaign ◽  
Fetal Demise ◽  
Major Morbidity ◽  
Mortality And Morbidity ◽  
Management Of Complications ◽  
Maternal Mortality And Morbidity ◽  
In Pregnancy

Sepsis in pregnancy and the puerperium remains a significant cause of maternal mortality and morbidity worldwide. Major morbidity arising as a result of obstetric sepsis includes fetal demise, organ failure, chronic pelvic inflammatory disease, chronic pelvic pain, bilateral tubal occlusion, and infertility. Sepsis may arise at any time during pregnancy and the puerperium. Prior to the advent of routine prophylactic antibiotics for caesarean delivery, endometritis used to be a major cause of postpartum infection. Diagnosis can be difficult as the physiological changes of pregnancy can overlap significantly with the pathophysiology of sepsis. The clinician must often rely on a high index of clinical suspicion rather than objective criteria. Women at risk of infection should be identified early in pregnancy. Management of the septic pregnant patient must encompass resuscitation, identification, and treatment of the source of sepsis and management of complications such as hypotension and tissue hypoxia. The Royal College of Obstetricians and Gynaecologists recommend that sepsis should be managed in accordance with the Surviving Sepsis Campaign guidelines. Anaesthetists have broad experience in all the elements required to care for a sick parturient and obstetric anaesthetists are key members of the team required to successfully manage these women.

Hypercalcemia-Induced Pancreatitis in Pregnancy Following Calcium Carbonate Ingestion

2017 ◽  
Vol 32 (2) ◽  
pp. 225-227 ◽  
Author(s):  
May S. Trezevant ◽  
John C. Winton ◽  
Ashley K. Holmes
Keyword(s):  
Abdominal Pain ◽  
Calcium Carbonate ◽  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Pregnant Patient ◽  
Abdominal Ultrasound ◽  
Laboratory Findings ◽  
Emergency Cesarean ◽  
Intravenous Fluid Administration ◽  
In Pregnancy

Background: Calcium carbonate is often used to relieve Gastroesophageal Reflux Disease (GERD) in pregnant patients. This report describes a potentially serious complication. Case: A pregnant female presented at 34 weeks gestation with abdominal pain, nausea, and vomiting. Home medications included an unquantifiable amount of calcium carbonate 500 mg due to constant consumption for GERD. Laboratory findings included elevated calcium, amylase, lipase, and triglyceride level. Pancreatitis was diagnosed and abdominal ultrasound excluded gallstones. Despite hydration, lipase rose and emergency cesarean section was performed. Hypercalcemia was managed by intravenous fluid administration. After delivery, pancreatitis resolved. Conclusion: Pancreatitis developed in pregnant patient with hypercalcemia due to excessive calcium carbonate ingestion and resolved after delivery of the fetus, fluid resuscitation, and return of calcium level to normal.

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 Spontaneous Rupture of Uterine Veins In Pregnancy

2013 ◽  
Vol 25 (2) ◽  
pp. 85-86 ◽  
Author(s):  
KH Shahnewaj ◽  
Md Al Sayed ◽  
Kauser Jabin
Keyword(s):  
Abdominal Pain ◽  
Maternal Mortality ◽  
Blood Vessels ◽  
Spontaneous Rupture ◽  
Unknown Origin ◽  
High Rate ◽  
Foetal Loss ◽  
Uterine Vessel ◽  
In Pregnancy ◽  
Uterine Vessels

Spontaneous rupture of uterine vessels during pregnancy is a rare cause of shock that has a  high rate of maternal and foetal loss. Though the usual presentation is of maternal shock, it  is necessary to have in mind that possibility of blood vessels rupture may be in cases of  abdominal pain & hypotension of unknown origin during pregnancy. In such an event an exploratory laparatomy followed by caesarean with ligation of the uterine  vessel or its branch can help in preventing a maternal mortality. The advent of modern  resuscitative facilities, anaesthesia techniques have lowered mortality associated with this condition from 49% to 3.6%. DOI: http://dx.doi.org/10.3329/bjog.v25i2.13745 Bangladesh J Obstet Gynaecol, 2010; Vol. 25(2) : 85-86  

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