title: Acute abdomen in pregnancy requiring surgical management: a 20-case series.
abstract: OBJECTIVE
  The obstetrician often has a difficult task in diagnosing and managing the acute abdomen in pregnancy. A reluctance to operate during pregnancy adds unnecessary delay, which may increase morbidity for both mother and fetus. In this study, we present our experience in pregnant patients with acute abdomen.
  
  
  METHODS
  Pregnant patients with acute abdomen requiring surgical exploration were enrolled from 2007 to 2010. Demographics, gestational age, symptoms, fetal loss, preterm delivery, imaging studies, operative results, postoperative complications and histopathologic evaluations were recorded. Ultrasound (US) and magnetic resonance (MR) imaging studies were evaluated. Data analyses were performed with Microsoft Excel and statistical evaluations were done by using Student's t-test.
  
  
  RESULTS
  There were 20 patients with a mean age of 32 years. The rate of emergency surgery was seen to be significantly higher in the second trimester (p<0.05). Most common symptoms were abdominal pain (100%) and nausea (80%). US was done in all patients while MR imaging was used in 30%. However, US findings were consistent with surgical findings in only 55%, while MR was successful in assigning the correct diagnosis in 83.3%. Appendicitis and adhesive small bowel obstruction were the most common etiologies causing acute abdomen (30% and 15%, respectively). All patients tolerated surgery well, and postoperative complications included wound infection, 10%, preterm labor, 5%, and prolonged paralytic ileus, 5%. One patient died from advanced gastric carcinoma and the only fetal death was seen in this case.
  
  
  CONCLUSIONS
  Prompt diagnosis and appropriate therapy are crucial in pregnant with acute abdomen. The use of US may be limited and CT is not desirable due to fetal irradiation. MR has thus become increasingly popular in the evaluation of such patients. Adhesive small bowel obstruction should be kept in mind as an important etiology.
authors.affiliation: Haydarpasa Numune Training and Research Hospital, Gynecology and Obstetrics Clinic, Istanbul, Turkey. aysunfirat@yahoo.com
authors.forename: Aysun
authors.initials: A
authors.lastname: Unal
authors.forename: Sema Etiz
authors.initials: SE
authors.lastname: Sayharman
authors.forename: Leyla
authors.initials: L
authors.lastname: Ozel
authors.forename: Ethem
authors.initials: E
authors.lastname: Unal
authors.forename: Nurettin
authors.initials: N
authors.lastname: Aka
authors.forename: Izzet
authors.initials: I
authors.lastname: Titiz
authors.forename: Gultekin
authors.initials: G
authors.lastname: Kose
mesh_terms: D000006:Abdomen, Acute / Q000175:diagnosis / Q000601:surgery*; D000328:Adult; D001064:Appendicitis / Q000175:diagnosis / Q000601:surgery; D005260:Female; D006801:Humans; D007415:Intestinal Obstruction / Q000175:diagnosis / Q000601:surgery; D007421:Intestine, Small / Q000601:surgery; D008279:Magnetic Resonance Imaging; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult