Kosmidis Christophoros, Anthimidis Georgios, Varsamis Nikolaos, Makedou Fotini, Georgakoudi Eleni, Efthimiadis Christophoros
Department of Surgery, Interbalkan European Medical Center, Thessaloniki, Greece.
Department of Oncology, Interbalkan European Medical Center, Thessaloniki, Greece.
Am J Case Rep. 2016 Feb 24;17:115-9. doi: 10.12659/ajcr.896017.
Differential diagnosis of acute abdomen in pregnant patients is one of the greatest challenges for the clinician. Occurrence of Familial Mediterranean Fever (FMF) paroxysm of peritonitis and acute cholecystitis during pregnancy is a unique clinical entity that leads to serious diagnostic and therapeutic dilemmas.
We present the case of a 33-year-old Armenian patient at 16 weeks' gestational age with a history of FMF, who was admitted twice within 1 month with acute abdomen. The first episode was attributed to FMF and successfully treated conservatively with colchicine. The second episode was diagnosed as acute cholecystitis and led to emergent laparoscopic cholecystectomy and lysis of peritoneal adhesions from previous FMF attacks. The patient presented an uneventful postoperative clinical course and had a normal delivery of a healthy infant at the 39th week of gestation.
Pregnant patients with acute abdomen should be evaluated with open mind. To the best of our knowledge, this is the first published report of the coexistence of 2 different causes of acute abdomen during pregnancy. Meticulous history and thorough physical, laboratory, and radiologic examination are the keys to reach a correct diagnosis. Treatment of pregnant patients with acute abdomen should be individualized. Administration of colchicine should be continued during conception, pregnancy, and lactation in patients with FMF history. Laparoscopic intervention in pregnant patients with surgical abdomen such as acute cholecystitis is the optimal method of treatment.
对临床医生而言，妊娠患者急腹症的鉴别诊断是最大挑战之一。妊娠期间家族性地中海热（FMF）腹膜炎发作与急性胆囊炎并存是一种独特的临床情况，会导致严重的诊断和治疗困境。
我们报告一例33岁、孕16周的亚美尼亚患者，有FMF病史，1个月内因急腹症入院两次。首次发作归因于FMF，用秋水仙碱保守治疗成功。第二次发作诊断为急性胆囊炎，行急诊腹腔镜胆囊切除术并松解既往FMF发作所致的腹膜粘连。患者术后临床过程平稳，孕39周顺产一健康婴儿。
对妊娠急腹症患者应保持开放的评估心态。据我们所知，这是首次发表的关于妊娠期间两种不同急腹症病因并存的报告。详尽的病史及全面的体格、实验室和影像学检查是做出正确诊断的关键。妊娠急腹症患者的治疗应个体化。有FMF病史的患者在受孕、妊娠及哺乳期应继续使用秋水仙碱。对有外科急腹症如急性胆囊炎的妊娠患者，腹腔镜干预是最佳治疗方法。
