ANC with acute abdomen: a case report from secondary care hospital, Western Maharashtra
Keywords:Aascular tumour, Sub-serosal fibroid, Ultrasonography, MRI, CT haemorrhagic corpus luteum, Non-viable heterotopic pregnancy emergency laparotomy, Peritoneal wash
Female body undergoes numerous anatomical and physiological changes in pregnancy which make diagnosis and management of acute abdomen in pregnancy as a most challenging situation. This may lead to dilemma and delayed identification of spectrum of causes of acute abdomen in pregnancy ultimately resulting in maternal and foetal morbidity and mortality. This case was to identify the spectrum of causes, the clinical presentation and diagnostic dilemma of acute abdomen in pregnancy. We presented one of the unusual and rare cause of acute abdomen with hemoperitoneum. Patient underwent emergency laparotomy with peritoneal wash with no obvious bleeding cause but evidence pointing towards vascular tumour or sub-serosal fibroid. The diagnosis remained obscured. The dilemma was attributed to higher radiological imaging with possibility of Haemorrhagic corpus luteum and non-viable heterotopic pregnancy. The cause of bleeding could not be identified with higher imaging due to contraindicated use of contrast enhanced MRI/CT and other alternatives due to radiation exposure in pregnancy. Diagnosis and treatment of acute abdomen in pregnancy should be individualized for better prognosis. Good clinical acumen is essential for ordering early diagnosis and intervention in acute abdomen in pregnancy.
Stedman’s. Stedman’s Medical Dictionary. 27th ed. Albins: Lippincott Williams and Wilkins; 2000.
Augustin G, Majerovic M. Non-obstetrical acute abdomen during pregnancy. Eur J Obstet Gynecol Reprod Biol. 2007;131(1):4-12.
Malangoni MA. Gastrointestinal surgery and pregnancy. Gastroenterol Clin North Am. 2003;32(1):181-200.
Saidi F, Constable JD, Ulfelder H. Massive intraperitoneal hemorrhage due to uterine fibroids. Am J Obstet Gynecol. 1961;82:367-74.
Elkbuli A, Shaikh S, McKenney M, Boneva D. Life-threatening hemoperitoneum secondary to rupture of a uterine leiomyoma: A case report and review of the literature. Int J Surg Case Rep. 2019;61:51-5.
Mattison DR, Yeh SY. Hemoperitoneum from rupture of a uterine vein overlying a leiomyoma. Am J Obstet Gynecol. 1980;136(3):415-6.
Pritchard JA, Baldwin RM, Dickey JC. Blood volume changes in pregnancy and the puerperium, II: red blood cell loss and changes in apparent blood volume during and following vaginal delivery, cesarean section, and cesarean section plus total hysterectomy. Am J Obstet Gynecol. 1962;84:1271.
Cappell MS. Risks versus benefits of gastrointestinal endoscopy during pregnancy. Nat Rev Gastroenterol Hepatol. 2011;8(11):610-34.
Cappell MS. The fetal safety and clinical efficacy of gastrointestinal endoscopy during pregnancy. Gastroenterol Clin North Am. 2003;32(1):123-79.
Bonde AA, Korngold EK, Foster BR. Radiological appearances of corpus luteum cysts and their imaging mimics. Abdom Radiol. 2016;41:2270-82.
Miyazaki T, Tanaka M, Miyakoshi K, Minegishi K, Kasai K, Yoshimura Y. Power and colour Doppler ultrasonography for the evaluation of the vasculature of the human corpus luteum. Hum Reprod. 1998;13(1O):2836-41.