Medical School, University of Bristol, Bristol, UK.
Severn School of Surgery, Bristol, UK.
Ann R Coll Surg Engl. 2021 May;103(5):e151-e155. doi: 10.1308/rcsann.2020.7143.
The diagnosis of visceral perforation during pregnancy is often delayed and the management complex. A 32-year-old primigravid woman in her second trimester presented with abdominal pain and a pre-existing ileoanal pouch. Initial imaging was negative but later imaging was suggestive of serious pathology. At laparotomy, a caesarean section was performed. Peritonitis was encountered secondary to two discrete perforations in the small bowel separate from her pouch. Histology found an ischaemic perforation secondary to a pressure effect from the gravid uterus. In pregnancy, ileoanal pouches may make the interconnected bowel vulnerable to the pressure effect of the gravid uterus and perforation. Pregnant women with such a surgical history who develop symptoms suggestive of bowel perforation should have rapid imaging and their clinical team should consider early definitive surgical intervention.
妊娠时内脏穿孔的诊断常常被延误，且处理复杂。一位 32 岁的初产妇，妊娠中期，表现为腹痛和既往的回肠贮袋。初始影像学检查阴性，但随后的影像学检查提示严重的病变。剖腹探查时，行剖宫产术。术中发现腹膜炎，原因是小肠有两处与贮袋不相关的穿孔。组织学检查发现缺血性穿孔，原因是妊娠子宫的压迫作用。在妊娠时，回肠贮袋可能使相互连通的肠管易受妊娠子宫压迫作用的影响而穿孔。有这种手术史的孕妇，若出现提示肠穿孔的症状，应迅速进行影像学检查，且其临床团队应考虑早期确定性手术干预。
