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J Visc Surg. 2015 Dec;152(6 Suppl):S105-15. doi: 10.1016/j.jviscsurg.2015.09.017. Epub 2015 Oct 30.

Abdominal emergencies during pregnancy.

Author information

1
Service de chirurgie digestive, hépatobiliaire et endocrinienne, Hôpital Cochin, AP-HP, Paris, France.
2
Service de chirurgie digestive, hépatobiliaire et endocrinienne, Hôpital Cochin, AP-HP, Paris, France; Faculté de médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
3
Faculté de médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Département de gynécologie-obstétrique II et médecine de la reproduction, Hôpital Cochin-Port Royal, AP-HP, Paris, France; DHU Risques et Grossesse, Université Paris Descartes, Paris, France.
4
Faculté de médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Maternité, Hôpital Cochin-Port Royal, Paris, France; DHU Risques et Grossesse, Université Paris Descartes, Paris, France.
5
Faculté de médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France; Département de gynécologie-obstétrique II et médecine de la reproduction, Hôpital Cochin-Port Royal, AP-HP, Paris, France.
6
Service de chirurgie digestive, hépatobiliaire et endocrinienne, Hôpital Cochin, AP-HP, Paris, France; Faculté de médecine, Université Paris Descartes, Sorbonne Paris Cité, Paris, France. Electronic address: bertrand.dousset@cch.aphp.fr.

Abstract

Abdominal emergencies during pregnancy (excluding obstetrical emergencies) occur in one out of 500-700 pregnancies and may involve gastrointestinal, gynecologic, urologic, vascular and traumatic etiologies; surgery is necessary in 0.2-2% of cases. Since these emergencies are relatively rare, patients should be referred to specialized centers where surgical, obstetrical and neonatal cares are available, particularly because surgical intervention increases the risk of premature labor. Clinical presentations may be atypical and misleading because of pregnancy-associated anatomical and physiologic alterations, which often result in diagnostic uncertainty and therapeutic delay with increased risks of maternal and infant morbidity. The most common abdominal emergencies are acute appendicitis (best treated by laparoscopic appendectomy), acute calculous cholecystitis (best treated by laparoscopic cholecystectomy from the first trimester through the early part of the third trimester) and intestinal obstruction (where medical treatment is the first-line approach, just as in the non-pregnant patient). Acute pancreatitis is rare, usually resulting from trans-ampullary passage of gallstones; it usually resolves with medical treatment but an elevated risk of recurrent episodes justifies laparoscopic cholecystectomy in the 2nd trimester and endoscopic sphincterotomy in the 3rd trimester. The aim of the present work is to review pregnancy-induced anatomical and physiological modifications, to describe the main abdominal emergencies during pregnancy, their specific features and their diagnostic and therapeutic management.

KEYWORDS:

Abdominal emergency; Laparoscopy; Pregnancy; Surgery

PMID:
26527261
DOI:
10.1016/j.jviscsurg.2015.09.017
[Indexed for MEDLINE]

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