妊娠合并急性肠梗阻:诊断与手术治疗
Acute intestinal obstruction complicating pregnancy: diagnosis and surgical management.
作者信息
Zachariah Sanoop Koshy, Fenn Miriam George
机构信息
Department of General, Gastrointestinal & Laparoscopic Surgery, MOSC Medical College, Cochin, Kerala, India.
出版信息
BMJ Case Rep. 2014 Mar 6;2014:bcr2013203235. doi: 10.1136/bcr-2013-203235.
Intestinal obstruction during pregnancy is an uncommon and serious non-obstetric surgical condition which may be associated with significant maternal and fetal mortality. Surgeons who are called upon to manage these patients are often confronted with a diagnostic and therapeutic challenge due to the rarity of the condition, overlapping symptomatology, concerns over radiological evaluation and risks involved with surgery and anaesthesia. We report a 31-year-old woman who presented with acute intestinal obstruction during the third trimester of pregnancy. Plain abdominal X-ray was diagnostic of intestinal obstruction. Conservative treatment was unsuccessful. On laparotomy, the small bowel was found to have twisted at three different sites due to adhesive bands from previous abdominal surgeries. Division of these bands released the obstruction. The child was delivered through a concomitant caesarean section. A high index of clinical suspicion coupled with timely surgical intervention increases the chances for a favourable outcome in these situations.
妊娠期肠梗阻是一种罕见且严重的非产科外科疾病,可能伴有较高的孕产妇和胎儿死亡率。由于这种疾病罕见、症状重叠、对放射学评估的担忧以及手术和麻醉相关风险,被要求处理这些患者的外科医生常常面临诊断和治疗挑战。我们报告一名31岁女性,在妊娠晚期出现急性肠梗阻。腹部平片诊断为肠梗阻。保守治疗失败。剖腹探查时发现,由于既往腹部手术形成的粘连带,小肠在三个不同部位发生扭转。切断这些粘连带解除了梗阻。同时通过剖宫产分娩出婴儿。在这些情况下,高度的临床怀疑加上及时的手术干预会增加获得良好结局的机会。