title: A patient with pregnancy-related acute abdomen after hemodialysis for over 18 years.
abstract: Because pregnancy is rare in women with end-stage renal disease, dialysis patients have not been reported to present with acute abdominal symptoms related to pregnancy including ectopic pregnancy. A 41-year-old woman treated with hemodialysis for over 18 years was brought to the emergency room at our institution because of acute abdominal pain. Ultrasonography detected an abdominal fluid collection, and her anemia had worsened (hematocrit 18%). Emergency laparoscopic exploration disclosed a hemorrhagic corpus luteum of pregnancy, causing ovarian bleeding on the left. Coagulation of bleeding points was carried out. At this time, pregnancy at 7 weeks of gestation was discovered. After the procedures, hemodialysis frequency was increased to 5 times weekly, and an erythropoietin derivative was administered to maintain a hematocrit above 30%. The patient developed no hypertension. At 33 weeks of gestation, cesarean section was performed because of a decrease in amniotic fluid and frequent late deceleration of the fetal heart rate. A live baby girl weighing 1,422 g was born. The successful pregnancy reflects remarkable progress in dialysis technology. Pregnancy, then, can underlie an acute abdomen in childbearing-age women (14 - 44 years old) undergoing long-term dialysis.
authors.affiliation: Nephrology Center and Department of Obstetrics, Toranomon Hospital, Tokyo, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Saito
authors.forename: Y
authors.initials: Y
authors.lastname: Ubara
authors.forename: T
authors.initials: T
authors.lastname: Suwabe
authors.forename: Y
authors.initials: Y
authors.lastname: Higa
authors.forename: Y
authors.initials: Y
authors.lastname: Higa
authors.forename: S
authors.initials: S
authors.lastname: Nakanishi
authors.forename: J
authors.initials: J
authors.lastname: Hoshino
authors.forename: N
authors.initials: N
authors.lastname: Sawa
authors.forename: H
authors.initials: H
authors.lastname: Katori
authors.forename: F
authors.initials: F
authors.lastname: Takemoto
authors.forename: R
authors.initials: R
authors.lastname: Marui
authors.forename: M
authors.initials: M
authors.lastname: Nakamura
authors.forename: S
authors.initials: S
authors.lastname: Tomikawa
authors.forename: S
authors.initials: S
authors.lastname: Hara
authors.forename: H
authors.initials: H
authors.lastname: Tohbai
authors.forename: K
authors.initials: K
authors.lastname: Takaichi
mesh_terms: D000006:Abdomen, Acute / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D000328:Adult; D002585:Cesarean Section; D003338:Corpus Luteum; D003937:Diagnosis, Differential; D019160:Endosonography; D005260:Female; D006470:Hemorrhage / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D006801:Humans; D007676:Kidney Failure, Chronic / Q000628:therapy; D010535:Laparoscopy; D011247:Pregnancy; D011256:Pregnancy Outcome; D006435:Renal Dialysis; D014057:Tomography, X-Ray Computed