title: Episode of Familial Mediterranean Fever-Related Peritonitis in the Second Trimester of Pregnancy Followed by Acute Cholecystitis: Dilemmas and Pitfalls.
abstract: BACKGROUND
  Differential diagnosis of acute abdomen in pregnant patients is one of the greatest challenges for the clinician. Occurrence of Familial Mediterranean Fever (FMF) paroxysm of peritonitis and acute cholecystitis during pregnancy is a unique clinical entity that leads to serious diagnostic and therapeutic dilemmas.
  
  
  METHODS
  We present the case of a 33-year-old Armenian patient at 16 weeks' gestational age with a history of FMF, who was admitted twice within 1 month with acute abdomen. The first episode was attributed to FMF and successfully treated conservatively with colchicine. The second episode was diagnosed as acute cholecystitis and led to emergent laparoscopic cholecystectomy and lysis of peritoneal adhesions from previous FMF attacks. The patient presented an uneventful postoperative clinical course and had a normal delivery of a healthy infant at the 39th week of gestation.
  
  
  CONCLUSIONS
  Pregnant patients with acute abdomen should be evaluated with open mind. To the best of our knowledge, this is the first published report of the coexistence of 2 different causes of acute abdomen during pregnancy. Meticulous history and thorough physical, laboratory, and radiologic examination are the keys to reach a correct diagnosis. Treatment of pregnant patients with acute abdomen should be individualized. Administration of colchicine should be continued during conception, pregnancy, and lactation in patients with FMF history. Laparoscopic intervention in pregnant patients with surgical abdomen such as acute cholecystitis is the optimal method of treatment.
authors.affiliation: Department of Surgery, Interbalkan European Medical Center, Thessaloniki, Greece.
authors.forename: Christophoros
authors.initials: C
authors.lastname: Kosmidis
authors.affiliation: Department of Surgery, Interbalkan European Medical Center, Thessaloniki, Greece.
authors.forename: Georgios
authors.initials: G
authors.lastname: Anthimidis
authors.affiliation: Department of Surgery, Interbalkan European Medical Center, Thessaloniki, Greece.
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Varsamis
authors.affiliation: Department of Oncology, Interbalkan European Medical Center, Thessaloniki, Greece.
authors.forename: Fotini
authors.initials: F
authors.lastname: Makedou
authors.affiliation: Faculty of Medicine, Aristotelian University of Thessaloniki (AUTh), Thessaloniki, Greece.
authors.forename: Eleni
authors.initials: E
authors.lastname: Georgakoudi
authors.affiliation: Department of Surgery, Interbalkan European Medical Center, Thessaloniki, Greece.
authors.forename: Christophoros
authors.initials: C
authors.lastname: Efthimiadis
mesh_terms: D000006:Abdomen, Acute / Q000175:diagnosis; D000328:Adult; D017081:Cholecystectomy, Laparoscopic; D041881:Cholecystitis, Acute / Q000175:diagnosis* / Q000601:surgery; D010505:Familial Mediterranean Fever / Q000150:complications*; D005260:Female; D006801:Humans; D010538:Peritonitis / Q000209:etiology*; D011247:Pregnancy; D011248:Pregnancy Complications; D011262:Pregnancy Trimester, Second