Oliveira Susana Patrícia Lima, Sousa Ana Isabel, Martins Nuno Nogueira
Department of Obstetrics and Gynecology, Centro Hospitalar Tondela-Viseu, Viseu, Portugal.
Case Rep Obstet Gynecol. 2022 Apr 21;2022:1249676. doi: 10.1155/2022/1249676. eCollection 2022.
Acute abdomen in pregnancy represents a diagnostic and therapeutic challenge, despite the current advances in modern medicine, since the typical symptoms and altered laboratory parameters mimic normal pregnancy. Acute appendicitis is the most common nonobstetric surgical emergency during pregnancy, with an incidence of 1 per 500-2000 pregnancies. Delayed diagnosis and reluctance to operate on a pregnant woman predispose to adverse maternal and fetal outcomes. The elective termination of pregnancy or interventions to prolong it in the presence of appendicitis is controversial. We present a case of a 38-year-old Caucasian woman, G2P0, admitted to the Obstetric Emergency Department at 13 4/7 weeks of gestation with a primary complaint of severe nausea and vomiting associated with progressive diffuse abdominal pain which had started 7 days before. After the difficulty of inherent differential diagnosis, she was diagnosed with generalized peritonitis due to acute perforated appendicitis. Prompt exploratory laparotomy with appendectomy and drainage of multiple abscesses were performed. Conservative obstetrical management was assumed, with subsequent periodic monitoring of the fetal focus. Due to abdominal compartment syndrome, the abdomen was left open for 4 days. After 7 days in the intensive care unit, recovery was favorable, pregnancy remained uneventful, and a healthy full-term baby was born 27 weeks later. This case represents a successful example of how the cooperation of the obstetrics and general surgery teams and the decision of conservative obstetrical management in the surgical environment contributed to optimizing maternal health, achieving the best obstetrical outcome.
妊娠期急腹症是一个诊断和治疗上的挑战，尽管现代医学目前已有进展，但由于典型症状和实验室参数的改变与正常妊娠相似。急性阑尾炎是妊娠期最常见的非产科外科急症，发病率为每500 - 2000次妊娠中有1例。诊断延迟以及不愿对孕妇进行手术会导致母婴不良结局。在阑尾炎存在的情况下，选择性终止妊娠或延长妊娠的干预措施存在争议。我们报告一例38岁的白种女性，G2P0，妊娠13 4/7周时因严重恶心、呕吐伴进行性弥漫性腹痛为主诉入院，腹痛始于7天前。经过固有的鉴别诊断困难后，她被诊断为急性穿孔性阑尾炎导致的弥漫性腹膜炎。立即进行了剖腹探查术、阑尾切除术和多个脓肿引流术。采取了保守的产科管理，随后定期监测胎儿情况。由于腹腔间隔室综合征，腹部敞开4天。在重症监护病房住了7天后，恢复良好，妊娠过程顺利，27周后生下一个健康的足月婴儿。这个病例代表了一个成功的例子，展示了产科和普通外科团队的合作以及在手术环境中采取保守产科管理的决策如何有助于优化产妇健康，实现最佳产科结局。
