1/41. Acute abdominal pain and urgency to defecate in the young and the old: a useful symptom-complex?In the belief that "pattern recognition" is an important first step of the diagnostic process, we report our observation of an uncommon and heretofore poorly documented symptom-complex in 10 patients, and suggest that the constellation of abdominal pain and urgency to defecate in the acutely ill surgical patient should raise the diagnostic possibility of intra-abdominal bleeding. In our experience, this is statistically likely to be associated with a ruptured abdominal aortic aneurysm in the old and a ruptured ectopic pregnancy in the young.- - - - - - - - - - ranking = 1keywords = pregnancy (Clic here for more details about this article) |
2/41. Primary repair of cornual rupture occurring at 21 weeks gestation and successful pregnancy outcome.The successful delivery in a 31 year old woman at 33 weeks gestation is reported, after repair to a cornual rupture which occurred at 21 weeks gestation. The patient exhibited acute abdominal pain and pending shock. Emergency laparotomy showed a cornual rupture and an intrauterine vital fetus having intact amnion membrane. On the patient's family's insistence, primary repair for a cornual rupture was performed and preservation of the fetus attempted. Postoperatively, tocolytic agent with ritodrine hydrochloride was administered and close follow-up of the patient was uneventful. The patient had a smooth obstetric course until 33 weeks gestation when premature rupture of the membranes occurred, soon followed by the onset of labour. She underwent an elective Caesarean section and delivered a normal male fetus weighing 2140 g with Apgar scores at 1, 5 and 10 min of 6, 8, and 9 respectively. Because of this successful outcome, we suggest that primary repair for such an unusual patient should be accepted.- - - - - - - - - - ranking = 4.7743368311703keywords = pregnancy, gestation (Clic here for more details about this article) |
3/41. Abdominal pregnancy in a 67-year-old woman undetected for 37 years. A case report.BACKGROUND: Abdominal pregnancy is an exceedingly rare occurrence, but even more unusual is prolonged retention of an advanced abdominal pregnancy with lithopedion formation. We present the case of prolonged retention of an advanced abdominal pregnancy in an elderly women. CASE: A 67-year-old, white woman presented to the emergency department with abdominal pain. An acute abdominal series revealed a fetal skeleton extending from the patient's pelvis to her lower costal margins. Pelvic examination revealed a normal postmenopausal uterus, and human chorionic gonadotropin was negative. On further questioning the patient reported that she had become pregnant 37 years earlier and was diagnosed as having a "missed" pregnancy. She refused intervention at that time but suffered no untoward consequences. She reported having had later a healthy intrauterine pregnancy, delivered vaginally at term. No attempt was made to remove the prior missed abdominal pregnancy. The acute pain episode resolved, and there was no surgical intervention. CONCLUSION: Abdominal pregnancies can have a complex course, and management decisions can be difficult. This case presents an unusual outcome of an advanced abdominal pregnancy and illustrates a unique approach to management.- - - - - - - - - - ranking = 11keywords = pregnancy (Clic here for more details about this article) |
4/41. Pelvic abscess in the second half of pregnancy after oocyte retrieval for in-vitro fertilization: case report.We describe a very late manifestation of pelvic abscesses after oocyte retrieval for in-vitro fertilization (IVF). In a twin pregnancy achieved after intracytoplasmic sperm injection, rupture of bilateral ovarian abscesses occurred at the end of the second trimester. An emergency laparotomy was necessary because of an acute abdomen. This complication led to severe maternal and neonatal morbidity, preterm birth and neonatal death. The rare occurrence of acute abdomen in pregnancy due to pelvic infection and the non-specific symptoms of a pelvic abscess after oocyte retrieval for IVF are discussed.- - - - - - - - - - ranking = 6keywords = pregnancy (Clic here for more details about this article) |
5/41. An unusual presentation of gestational trophoblastic disease.We report a case of gestational trophoblastic disease leading to an acute abdomen due to a haemoperitoneum in a young multipara.- - - - - - - - - - ranking = 0.55309773655025keywords = gestation (Clic here for more details about this article) |
6/41. Heterotopic pregnancy presenting as an acute abdomen: a diagnostic masquerader.Simultaneous intrauterine and extrauterine pregnancy is called heterotopic pregnancy. It is a rare complication of pregnancy, especially in the absence of predisposing factors. It is known to present with a variety of symptoms and signs often leading to a delay in establishing the correct diagnosis. We report the case of a 29-year-old woman, known to be 14 weeks pregnant, presenting with acute abdominal pain. The confirmation of a viable intrauterine pregnancy led to a general surgery consultation. A heterotopic ruptured right ectopic tubal pregnancy was found. Right salpingectomy was performed. The patient recovered uneventfully. The intrauterine pregnancy was not affected. This case illustrates the variable presentation of heterotopic pregnancy and the need for general surgeons to be suspicious of pregnancy related complications, even in the presence of a viable intrauterine pregnancy.- - - - - - - - - - ranking = 13keywords = pregnancy (Clic here for more details about this article) |
7/41. Spontaneous rupture of hepatocellular carcinoma during pregnancy.BACKGROUND: Hepatocellular carcinoma associated with pregnancy is unusual. CASE: A 33-year-old woman presented at 25 weeks' gestation with sudden, severe epigastric pain for 6 hours. Abdominal ultrasonography and magnetic resonance imaging showed multiple liver tumors with a small amount of ascites. Exploratory laparotomy revealed an unresectable ruptured liver tumor that was treated by packing. Although a biopsy was nondiagnostic, ultrasound-guided needle biopsy 6 days after cesarean delivery at 41 weeks' gestation showed hepatocellular carcinoma, which was treated with transarterial embolization. At 3.5 years posttherapy, both mother and infant are well. CONCLUSION: Ruptured hepatocellular carcinoma during pregnancy is rare but should be included in the differential diagnosis of sudden, severe epigastric pain.- - - - - - - - - - ranking = 6.2212390946201keywords = pregnancy, gestation (Clic here for more details about this article) |
8/41. Ruptured degenerated uterine fibroid diagnosed by imaging.BACKGROUND: We report a ruptured uterine leiomyoma presenting as an acute abdomen. We document computed tomography and magnetic resonance imaging features of a ruptured uterine fibroid. CASE: A woman with a large anterior wall uterine fibroid underwent a dilation and curettage for a threatened abortion. She had an uneventful recovery. Three weeks later, she presented with peritonitis. Computed tomography and magnetic resonance imaging optimally depicted the ruptured fibroid and excluded other causes of acute abdomen. Exploratory laparotomy and myomectomy confirmed the diagnosis. CONCLUSION: This is a report of a ruptured degenerated fibroid causing acute abdomen outside of pregnancy. Computed tomography and magnetic resonance imaging aided in correctly establishing the diagnosis and optimizing the management of this patient.- - - - - - - - - - ranking = 1keywords = pregnancy (Clic here for more details about this article) |
9/41. Spontaneous heterotopic pregnancy presenting with tubal abortion.Heterotopic pregnancies are rarely spontaneous. We present the case of a woman who presented with acute abdominal pain. Emergency laparotomy was performed. Intraoperative finding showed right tubal pregnancy and right salpingectomy was performed. Six weeks post-operation, the patient's symptoms and signs of pregnancy persisted and ultrasound showed an intrauterine single viable fetus. The pregnancy was continued to term and a healthy female baby was delivered.- - - - - - - - - - ranking = 7keywords = pregnancy (Clic here for more details about this article) |
10/41. Abdominal surgical emergencies in the puerperium.Since surgical emergencies in the puerperium are rare, surgeons and obstetricians amass little experience of them. There may be considerable delay in making a diagnosis, firstly, because the abdominal symptoms are thought to be related to the pregnancy, and, secondly, because the signs are rarely convincing in contrast to the symptoms. Any of the common surgical emergencies may occur in pregnancy and the puerperium and there are some others that appear to be a particullar problem of the puerperium.- - - - - - - - - - ranking = 2keywords = pregnancy (Clic here for more details about this article) |
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