Haydarpasa Numune Training and Research Hospital, Gynecology and Obstetrics Clinic, Istanbul, Turkey.
Eur J Obstet Gynecol Reprod Biol. 2011 Nov;159(1):87-90. doi: 10.1016/j.ejogrb.2011.07.028. Epub 2011 Aug 9.
The obstetrician often has a difficult task in diagnosing and managing the acute abdomen in pregnancy. A reluctance to operate during pregnancy adds unnecessary delay, which may increase morbidity for both mother and fetus. In this study, we present our experience in pregnant patients with acute abdomen.
Pregnant patients with acute abdomen requiring surgical exploration were enrolled from 2007 to 2010. Demographics, gestational age, symptoms, fetal loss, preterm delivery, imaging studies, operative results, postoperative complications and histopathologic evaluations were recorded. Ultrasound (US) and magnetic resonance (MR) imaging studies were evaluated. Data analyses were performed with Microsoft Excel and statistical evaluations were done by using Student's t-test.
There were 20 patients with a mean age of 32 years. The rate of emergency surgery was seen to be significantly higher in the second trimester (p<0.05). Most common symptoms were abdominal pain (100%) and nausea (80%). US was done in all patients while MR imaging was used in 30%. However, US findings were consistent with surgical findings in only 55%, while MR was successful in assigning the correct diagnosis in 83.3%. Appendicitis and adhesive small bowel obstruction were the most common etiologies causing acute abdomen (30% and 15%, respectively). All patients tolerated surgery well, and postoperative complications included wound infection, 10%, preterm labor, 5%, and prolonged paralytic ileus, 5%. One patient died from advanced gastric carcinoma and the only fetal death was seen in this case.
Prompt diagnosis and appropriate therapy are crucial in pregnant with acute abdomen. The use of US may be limited and CT is not desirable due to fetal irradiation. MR has thus become increasingly popular in the evaluation of such patients. Adhesive small bowel obstruction should be kept in mind as an important etiology.
妇产科医生在诊断和处理妊娠急性腹痛时常常面临困难。由于担心对孕妇进行手术，可能会导致不必要的延误，从而增加母婴的发病率。本研究旨在报告妊娠合并急性腹痛患者的诊治经验。
回顾性分析 2007 年至 2010 年因急性腹痛需要手术探查的妊娠患者。记录患者的一般资料、妊娠周数、症状、胎儿丢失、早产、影像学检查、手术结果、术后并发症和组织病理学评估。评估超声（US）和磁共振（MR）成像检查。采用 Microsoft Excel 进行数据分析，采用 Student's t 检验进行统计学评估。
共纳入 20 例患者，平均年龄为 32 岁。急诊手术率在孕中期明显升高（p<0.05）。最常见的症状为腹痛（100%）和恶心（80%）。所有患者均行 US 检查，30%患者行 MR 检查。然而，US 检查结果与手术结果的一致性仅为 55%，而 MR 检查正确诊断率为 83.3%。引起急性腹痛的最常见病因分别为阑尾炎（30%）和粘连性小肠梗阻（15%）。所有患者均能耐受手术，术后并发症包括切口感染（10%）、早产（5%）和麻痹性肠梗阻（5%）。1 例患者因进展期胃癌死亡，唯一的胎儿死亡发生在该例患者。
及时诊断和恰当治疗对妊娠合并急性腹痛至关重要。由于胎儿辐射，US 可能受限，CT 也不适用。因此，MR 在这类患者的评估中越来越受欢迎。粘连性小肠梗阻应作为一个重要的病因加以考虑。
