Haghiri Mansooreh, Borna Sedigheh, Hessami Kamran, Sharifi Ali, Tafti Seyed Mohsen Ahmadi, Malek Mahrooz, Pourdamghan Nasim, Hantoushzadeh Sedigheh, Shirdel Abdolmaleki Abolfazl, Saleh Maasoumeh
Maternal, Fetal and Neonatal Research Center, Vali-e-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX, USA.
Case Rep Obstet Gynecol. 2022 Feb 9;2022:3516542. doi: 10.1155/2022/3516542. eCollection 2022.
Intractable vomiting and elevated liver enzymes during pregnancy seem to be associated to the obstetric etiologies; however, other causes such as acute surgical emergencies should be considered. The patient was a 26-year-old woman at 18 weeks of gestation with intractable vomiting, intolerability of oral intake, weight loss, and absence of abdominal pain. Her physical examinations and laboratory tests had no remarkable findings except elevated liver function test (LFT) and hypokalemia. Considering the lab data and normal abdominopelvic ultrasound, magnetic resonance imaging was performed which revealed dilation of the D1-3 and collapse the D4 sections of duodenum. She underwent exploratory laparotomy which confirmed duodenal obstruction caused by Ladd's band. After the Ladd's operation, the patient started oral intake of nutritious, and her LFT decreased to normal ranges. After the last follow-up, she has had gained 18 kg and gave birth at 36 weeks of gestation due to the premature rapture of membranes and delivered a 2 kg small for gestational age otherwise healthy infant. The experience gained from this case was to consider all possibilities (such as small bowel obstruction) and evaluate them in a pregnant patient to consider other causes of nausea, vomiting, and abnormal LFTs in a pregnant patient.
孕期顽固性呕吐和肝酶升高似乎与产科病因有关；然而，应考虑其他原因，如急性外科急症。患者为一名26岁女性，妊娠18周，有顽固性呕吐、无法耐受经口摄入、体重减轻且无腹痛。除肝功能检查（LFT）升高和低钾血症外，其体格检查和实验室检查均无明显异常。考虑到实验室数据和腹盆腔超声正常，遂进行磁共振成像检查，结果显示十二指肠D1 - 3段扩张，D4段塌陷。她接受了剖腹探查术，证实为Ladd束导致的十二指肠梗阻。Ladd手术后，患者开始经口摄入营养物质，其肝功能检查结果降至正常范围。最后一次随访时，她体重增加了18千克，因胎膜早破于妊娠36周分娩，产下一名体重2千克、小于孕周但其他方面健康的婴儿。从该病例中获得的经验是，对于孕妇要考虑所有可能性（如小肠梗阻）并进行评估，以考虑孕妇恶心、呕吐及肝功能检查异常的其他原因。
