Augustin G, Vrcic H, Zupancic B
Department of Surgery, University Hospital Center Zagreb, Kišpaticeva 12, Croatia.
J Postgrad Med. 2012 Oct-Dec;58(4):298-300. doi: 10.4103/0022-3859.105455.
The most common cases of acute abdomen during pregnancy are acute appendicitis followed by acute cholecystitis. The case presented is a 33-year-old patient in 16 weeks' in vitro fertilization and embryo transfer pregnancy who developed acute cholecystitis. Previously there were two unsuccessful cycles, one complicated with ovarian hyperstimulation syndrome. Due to clinical deterioration during intravenous antibiotic therapy laparoscopic cholecystectomy was performed and acute cholecystitis found. The postoperative course was uneventful. During the first 24 h tocolysis with intravenous fenoterol in addition to peroral atenolol 2 Χ 50 mg was administered. Postoperative course was uneventful with further normal pregnancy. Elective cesarean section was made in term pregnancy (39 weeks) with singleton with Apgar 10/10. Current guidelines do not recommend prophylactic tocolysis in pregnant population with acute abdomen but there is no mention of the IVF-ET subpopulation of patients. Also, there are no guidelines for thromboprophylaxis in such patients with increased risk of thromboembolic accidents. To our knowledge this is the first case report of a laparoscopic cholecystectomy during IVF-ET gestation.
孕期急腹症最常见的病例是急性阑尾炎，其次是急性胆囊炎。本文报道的病例是一名33岁的患者，在体外受精和胚胎移植妊娠16周时发生了急性胆囊炎。此前有两个周期未成功，其中一个周期并发卵巢过度刺激综合征。由于静脉抗生素治疗期间临床症状恶化，遂行腹腔镜胆囊切除术，术中发现急性胆囊炎。术后病程平稳。术后最初24小时，除口服阿替洛尔2×50mg外，还静脉给予了非诺特罗进行保胎治疗。术后病程平稳，妊娠继续正常进行。足月妊娠（39周）时行择期剖宫产，单胎，阿氏评分10/10。目前的指南不建议对患有急腹症的孕妇进行预防性保胎治疗，但未提及体外受精-胚胎移植患者亚群。此外，对于此类血栓栓塞事故风险增加的患者，也没有血栓预防指南。据我们所知，这是首例关于体外受精-胚胎移植妊娠期间行腹腔镜胆囊切除术的病例报告。
