Milczarek-Łukowiak Maria, Pyziak Andrzej, Kocemba Wojciech, Płusajska Justyna
Oddział Połozniczo-Ginekologiczny, Tomaszowskie Centrum Zdrowia, Tomaszów Mazowiecki, Polska.
Ginekol Pol. 2012 Dec;83(12):943-5.
Peritonitis is a set of symptoms of varying etiology usually with an accompanying infection, systemic and local changes within the peritoneal cavity Colonic diseases, especially colon perforation, are one of the most common causes of peritonitis. The course of the disease may be turbulent due to sudden perforation. In case of limited peritonitis the disease is not as acute as the perforation hole is small and it can be sealed by the omentum and internal organs. Abdominal pain is usually located around the source of infection and is less severe. A 38-year-old patient at 34 weeks gestation was hospitalized in the obstetric-gynecological ward of the Health Care Center with a diagnosis of preterm delivery urinary infection and renal colic. Due to increasing peritoneal symptoms and deteriorating general condition of the patient, a decision to perform immediately exploratory laparotomy combined with the Cesarean section was made. The surgeon indicated a place in the left mesogastrium that could correspond with a drained interintestinal abscess and also found a large amount of fibrin in the lower floor of the peritoneal cavity The initial point of the abscess remained unknown and the patient received total parenteral nutrition for 10 days. On 5 postoperative day the drain was removed from the peritoneal cavity and since day 10 patient health was steadily improving. Bacteriological cultures revealed abundant growth of E. coli that showed sensitivity to the used antibiotics. On 22 postoperative day the patient and her child were discharged home in good condition. Five months later the patient was admitted to the surgical ward with acute abdominal pain with the diagnosis of an abscess in her left mesogastric and subgastric area, perforation of sigmoid diverticulum and fecal fistula. Our case illustrates great difficulties in diagnosing diseases of the abdominal cavity during pregnancy because causes and symptoms may be typical of this condition, as well as of unrelated diseases, including: kidney problems, appendicitis, cholecystitis and bowel disease. Examination of the pregnant patient presents a challenge and the symptoms are uncharacteristic. Tension of the abdominal wall, as well as the muscles of the digestive and urinary tract are reduced and the topography of the internal organs changes during pregnancy. The interpretation of laboratory tests becomes more difficult. In our case, the initial local peritonitis, caused by microperforation of the diverticulum, ran a latent course and was masked by both pregnancy and renal colic symptoms, consequently leading to diffuse peritonitis. The presented case demonstrates the importance of the problem and forces obstetricians to be more vigilant in determining the diagnosis and decision-making, because of its meaning for the health and even the life of the patient and her child.
腹膜炎是一组病因各异的症状，通常伴有感染，腹膜腔内会出现全身性和局部性变化。结肠疾病，尤其是结肠穿孔，是腹膜炎最常见的病因之一。由于突然穿孔，疾病过程可能较为凶险。在局限性腹膜炎的情况下，病情没有那么急性，因为穿孔孔较小，大网膜和内脏可以将其封闭。腹痛通常位于感染源周围，程度较轻。一名38岁、孕34周的患者因早产、泌尿道感染和肾绞痛的诊断入住医疗中心的妇产科病房。由于患者腹膜症状加重且全身状况恶化，决定立即进行剖腹探查术并同时进行剖宫产。外科医生指出左胃系膜处有一个位置可能与一个引流的肠间脓肿相对应，并且在腹膜腔下层发现了大量纤维蛋白。脓肿的起始点仍然不明，患者接受了10天的全胃肠外营养。术后第5天，从腹膜腔拔除引流管，自第10天起患者健康状况稳步改善。细菌培养显示大肠杆菌大量生长，对所用抗生素敏感。术后第22天，患者和她的孩子状况良好出院。五个月后，患者因急性腹痛入住外科病房，诊断为左胃系膜和胃下区域脓肿、乙状结肠憩室穿孔和粪瘘。我们的病例说明了孕期诊断腹腔疾病存在很大困难，因为病因和症状可能是这种情况所特有的，也可能是与孕期无关的疾病所特有的，包括：肾脏问题、阑尾炎、胆囊炎和肠道疾病。对孕妇进行检查是一项挑战，而且症状不典型。腹壁以及消化道和泌尿道的肌肉张力降低，孕期内脏的位置也会发生变化。实验室检查结果的解读变得更加困难。在我们的病例中，由憩室微穿孔引起的初始局限性腹膜炎呈隐匿性病程，被妊娠和肾绞痛症状掩盖，最终导致弥漫性腹膜炎。该病例表明了这个问题的重要性，促使产科医生在诊断和决策时更加警惕，因为这对患者及其孩子的健康甚至生命都有意义。
