Surgical causes of acute abdominal pain in pregnancy

Abstract

Key content Abdominal pain in pregnancy is common, with a differential diagnosis that can encompass obstetric, surgical and medical conditions. Presentation of common surgical problems can be atypical in pregnancy, potentially delaying diagnosis. Surgical causes of abdominal pain to consider in pregnancy include appendicitis, cholecystitis, bowel obstruction, ureteric obstruction, pancreatitis and aneurysm rupture, most commonly involving the splenic artery. The management of surgical conditions in pregnancy requires continuing evaluation and potential modification to balance the medical, surgical and obstetric challenges. Management of the pregnant woman with a surgical cause of abdominal pain requires collaborative, multispecialty practice to optimise care of the mother and baby. Learning objectives To highlight the differential diagnoses of abdominal pain in pregnancy. To develop a structured assessment process for pregnant women with abdominal pain. To update the obstetrician on the priorities of surgical management for abdominal pain in pregnancy. Ethical issues Evaluating the risks of surgical interventions on the mother and baby with the high potential for premature delivery.

Prevalence, Aetiology, and Clinical Profile of Acute Abdomen in Pregnancy in Southwest Cameroon: A 5-Year Retrospective Study

“…Acute appendicitis was the most common non-obstetric surgical aetiology of acute abdomen in our study. This finding was consistent with previous studies in neighbouring Nigeria [12] [13], the United Kingdom [14] [15], and India [16].…”

Hypertriglyceridemia triggered acute pancreatitis in pregnancy – diagnostic approach, management and follow-up care

“…Acute medical and surgical conditions presenting with acute abdominal pain must be excluded: myocardial infarction, peptic ulcer, appendicitis, cholecystitis, acute mesenteric ischemia, gastro-intestinal or pancreatic cancer, pyelonephritis etc. Furthermore, obstetric complications must be taken into consideration and carefully ruled outacute fatty liver of pregnancy, preeclampsia, HELLP syndrome, placental abruption, uterine rupture [22]. The setting of abdominal pain in patients with advanced gestation is particular due to the presence of the enlarged uterus with mechanic upward and lateral displacement on maternal organs, as well as to physiologic changes in pain perception [23].…”

Splenic artery aneurysm rupture in pregnancy: challenges in diagnosis and the importance of multidisciplinary management

“…Obstetric causes of abdominal pain to be considered include abruption, uterine rupture and preterm labour; signs of these are at the forefront of an obstetrician’s mind during clinical review. If these diagnoses are ruled out, it is necessary then to work through the surgical sieve of other possible causes of abdominal pain 5…”

“…While surgical abdomen is an infrequent presentation to maternity units, knowledge of appropriate investigations and care is important as obstetricians have a key role in the MDT management of cases to ensure normal provision of care is not withheld due to the patient being pregnant 5. All too frequently, it is fear of radiation and intervention that would be offered to non-pregnant women that contributes to increased morbidity and mortality to the pregnant patient population 6…”