O&G Forum

OBSTETRICS & GYNAECOLOGY FORUM 2022 | ISSUE 3 | 31 Since splenectomy is associated with reduced immune competence, splenic preservation is preferred, as was done in our case. Conclusion Acute abdomen inpregnancy canpresent adiagnostic conundrum. Spontaneous splenic injury should be included in the di erential diagnosis of acute abdomen with shock in pregnancy. Early surgical intervention and management improve foetal as well as maternal survival. References 1. Cappell MS, Friedel D. Abdominal pain during pregnancy. Gastroenterol Clin North Am 2003;32(1):1-58. https://doi. org/10.1016/s0889-8553(02)00064-x 2. Sharp HT. e acute abdomen during pregnancy. Clin Obstet Gynecol 2002;45(2):405-413. https://doi.org/10.1097/00003081- 200206000-00011 3. Wood eld CA, Lazarus E, Chen KC, Mayo-SmithWW. Abdominal pain in pregnancy: diagnoses and imaging unique to pregnancy--review. AJR Am J Roentgenol 2010;194(6 Suppl):WS14-WS30. https://doi.org/10.2214/AJR.07.7139 4. Mayer IE, Hussain H. Abdominal pain during pregnancy. Gastroenterol Clin North Am 1998;27(1):1-36. https://doi. org/10.1016/s0889-8553(05)70346-0 5. Tan EK, Tan EL. Alterations in physiology and anatomy during pregnancy. Best Pract Res Clin Obstet Gynaecol 2013;27(6):791- 802. https://doi.org/10.1016/j.bpobgyn.2013.08.001 6. Zachariah SK, Fenn M, Jacob K, Arthungal SA, Zachariah SA. Management of acute abdomen in pregnancy: current perspectives. Int J Womens Health 2019;11:119-134. https://doi. org/10.2147/IJWH.S151501 7. Soma-Pillay P, Nelson-Piercy C, Tolppanen H, Mebazaa A. Physiological changes in pregnancy. Cardiovasc J Afr 2016;27(2):89-94. https://doi.org/10.5830/CVJA-2016-021 8. American College of Obstetrics and Gynecology. ACOG (American College of Obstetrics and Gynecology) Practice Bulletin: nausea and vomiting of pregnancy. Obstet Gynecol 2004;103(4):803-814. 9. Nair U. Acute abdomen and abdominal pain in pregnancy. Curr Obstet Gynaecol 2003;13(1):14–20. https://doi.org/10.1054/ cuog.2003.0302 10. Brennan MC, Moore LE. Pulmonary embolism and amniotic uid embolism in pregnancy. Obstet Gynecol Clin North Am 2013;40(1):27-35. https://doi.org/10.1016/j.ogc.2012.11.005 11. Nawaz N, Buksh AR. Amniotic uid embolism. J Coll Physicians Surg Pak 2018;28(6):S107-S109. https://doi.org/10.29271/ jcpsp.2018.06.S107 12. Leal RF, Luz RM, de Almeida JP, Duarte V, Matos I. Total and acute uterine inversion a er delivery: a case report. J Med Case Rep 2014;8:347. https://doi.org/10.1186/1752-1947-8-347 13. Buddeberg BS, Aveling W. Puerperal sepsis in the 21st century: progress, new challenges and the situation worldwide. Postgrad Med J 2015;91(1080):572-578. https://doi.org/10.1136/ postgradmedj-2015-133475 14. Baird DD, Dunson DB, Hill MC, Cousins D, Schectman JM. High cumulative incidence of uterine leiomyoma in black and white women: ultrasound evidence. Am J Obstet Gynecol 2003;188(1):100-107. https://doi.org/10.1067/mob.2003.99 15. Lev-Toa AS, Coleman BG, Arger PH, Mintz MC, Arenson RL, Toa ME. Leiomyomas in pregnancy: sonographic study. Radiology. 1987;164(2):375-380. https://doi.org/10.1148/ radiology.164.2.3299488 16. Andersson RE, Lambe M. Incidence of appendicitis during pregnancy. Int J Epidemiol 2001;30(6):1281-1285. https://doi. org/10.1093/ije/30.6.1281 17. Angelini DJ. Obstetric triage revisited: update on non-obstetric surgical conditions in pregnancy. J Midwifery Womens Health 2003;48(2):111-118. https://doi.org/10.1016/s1526- 9523(02)00417-8 18. Williams R, Shaw J. Ultrasound scanning in the diagnosis of acute appendicitis in pregnancy. Emerg Med J 2007;24(5):359-360. https://doi.org/10.1136/emj.2007.048488 19. Expert Panel on Gastrointestinal Imaging:, Garcia EM, Camacho MA, Karolyi DR, KimDH, Cash BD, et al. ACR Appropriateness Criteria® Right Lower Quadrant Pain-Suspected Appendicitis. J Am Coll Radiol 2018;15(11S):S373-S387. https://doi. org/10.1016/j.jacr.2018.09.033 20. A eck DG, Handrahan DL, Egger MJ, Price RR. e laparoscopic management of appendicitis and cholelithiasis during pregnancy. Am J Surg 1999;178(6):523-529. https://doi.org/10.1016/s0002- 9610(99)00244-5 21. Landers D, Carmona R, Crombleholme W, Lim R. Acute cholecystitis in pregnancy. Obstet Gynecol 1987;69(1):131-133. 22. 22. BuchsbaumHJ. Splenic rupture in pregnancy. Report of a case and review of the literature. Obstet Gynecol Surv 1967;22(3):381- 395. 23. 23. Ho man RL. Rupture of the spleen: a review and report of a case following abdominal hysterectomy. Am J Obstet Gynecol 1972;113(4):524-530. https://doi.org/10.1016/S0002- 9378(15)32503-5 24. Sivaslıoğlu AA, Demir B, Gelişen O, DilbazS, Şahin Y, Dölen I. A case of atraumatic splenic rupture in twin pregnancy. Gynecol Obstet Reprod Med 2006;12:145-146. 25. McCormick GM 2nd, Young DB. Spontaneous rupture of the spleen. A fatal complication of pregnancy. Am J Forensic Med Pathol 1995;16(2):132-134. https://doi.org/10.1097/00000433- 199506000-00010 26. Denehy T, McGrath EW, Breen JL. Splenic torsion and rupture in pregnancy. Obstet Gynecol Surv 1988;43(3):123-131. 27. de Graa J, Pijpers PM. Spontaneous rupture of the spleen in third trimester of pregnancy. Report of a case and review of the literature. Eur J Obstet Gynecol Reprod Biol 1987;25(3):243-247. https://doi.org/10.1016/0028-2243 (87)90105-5 28. Hamedi B, Shomali Z. Postpartum spontaneous rupture of spleen in a woman with severe oreeclampsia: case report and review of the literature. Bull Emerg Trauma 2013;1(1):46-48. 29. Bljajić D, Ivanisević M, Djelmis J, Majerović M, Starcević V. Splenic rupture in pregnancy--traumatic or spontaneous event? Eur J Obstet Gynecol Reprod Biol 2004;115(1):113-114. https:// doi.org/10.1016/j.ejogrb.2003.10.028 30. Elghanmi A, Mohamed J, Khabouz S. Spontaneous splenic rupture in pregnancy. Pan Afr Med J 2015;21:312. https://doi. org/10.11604/pamj.2015.21.312.6878 31. Pearson J, Alvi A, Hashemi M. Splenic rupture as an unusual cause of massive hematemesis. J Trauma 2007;63(4):E88-E89. https://doi.org/10.1097/01.ta.0000195508.27907.df 32. Augustin G, Majerovic M. Non-obstetrical acute abdomen during pregnancy. Eur J Obstet Gynecol Reprod Biol 2007;131(1):4-12. https://doi.org/10.1016/j.ejogrb.2006.07.052 O&G Forum 2022; 32: 28-31 CASE REPORT