Acute Abdomen During Pregnancy
Acute Abdomen During Pregnancy
Part I Surgery
1 Acute Appendicitis. 3
1.1 History. 3
1.2 Incidence, Etiology, and Pathogenesis. 3
1.3 History Taking and Clinical Examination. 5
1.4 Examination. 7
1.4.1 Scoring Systems. 8
1.5 Differential Diagnosis. 9
1.5.1 Round Ligament Pain Syndrome. 9
1.5.2 Ovarian Vein Thrombosis. 10
1.5.3 Pathologic Conditions Associated with the Puerperium. 10
1.6 Diagnosis. 11
1.6.1 Introduction. 11
1.6.2 Laboratory Findings. 12
1.6.3 Transvaginal Ultrasound. 12
1.6.4 Graded Abdominal Ultrasound. 13
1.6.5 Magnetic Resonance Imaging. 13
1.6.6 Computed Tomography CT Scan. 15
1.6.7 Chest Radiograph. 16
1.7 Negative Appendectomy. 16
1.7.1 Incidence. 16
1.7.2 Indications for Appendectomy. 17
1.7.3 Perinatal Outcome. 18
1.8 Management. 18
1.8.1 Anesthetic Considerations. 18
1.8.2 Open Appendectomy. 18
1.8.3 Laparoscopic Appendectomy. 19
1.8.4 Conversion from Laparoscopic to Open Approach. 22
1.8.5 Perioperative Considerations. 22
1.9 Specific Considerations. 26
1.9.1 Incidental Meckel s Diverticulum. 26
1.9.2 Acute Appendicitis and Ectopic Heterotopic Pregnancy. 27
1.9.3 Acute Appendicitis in Patients with In Vitro Fertilization and Embryo Transfer. 27
1.9.4 Acute Appendicitis and Sickle Cell Disease. 30
1.9.5 Appendiceal Endometriosis Presenting as Acute Appendicitis. 30
1.9.6 Surgical Considerations in the Postpartum Period. 31
1.10 Prognosis. 32
1.10.1 Perforation Rate. 32
1.10.2 Fetal Outcome. 33
1.10.3 Maternal Outcome. 34
References. 34
2 Acute Biliary Tract Diseases. 45
2.1 Acute Cholecystitis Biliary Colic. 45
2.1.1 History. 45
2.1.2 Incidence. 45
2.1.3 Risk Factors. 46
2.1.4 Pathophysiology. 47
2.1.5 Clinical Presentation. 50
2.1.6 Differential Diagnosis. 51
2.1.7 Diagnosis. 52
2.1.8 Treatment. 53
2.1.9 Prognosis. 69
2.2 Common Bile Duct Stones, Cholangitis, and Biliary Pancreatitis. 70
2.2.1 Incidence. 70
2.2.2 History. 70
2.2.3 Examination. 70
2.2.4 Differential Diagnosis. 70
2.2.5 Diagnosis. 72
2.2.6 Therapy. 75
2.2.7 Prognosis. 78
2.3 Symptomatic Choledochal Cysts. 78
2.3.1 History. 78
2.3.2 Incidence. 78
2.3.3 Clinical Presentation. 78
2.3.4 Diagnosis. 79
2.3.5 Therapy. 79
References. 80
3 Acute Pancreatitis. 91
3.1 History. 91
3.2 Incidence. 91
3.2.1 Incidence in General Population. 91
3.2.2 Incidence in Pregnancy. 91
3.3 Etiopathogenesis. 93
3.3.1 Introduction. 93
3.3.2 Primary Hyperparathyroidism. 94
3.3.3 Acute Fatty Liver of Pregnancy. 97
3.3.4 Hyperlipidemia Hypertriglyceridemia. 97
3.3.5 Alcohol. 102
3.3.6 Medications. 103
3.3.7 In Vitro Fertilization. 104
3.3.8 Postpartum Acute Pancreatitis. 104
3.3.9 Preeclampsia-Eclampsia. 105
3.3.10 Placental Abruption. 105
3.4 Clinical Features. 105
3.4.1 History Taking. 105
3.4.2 Clinical Presentation. 105
3.4.3 Physical Examination. 107
3.5 Diagnosis. 108
3.5.1 Laboratory Findings. 108
3.5.2 Imaging Methods. 111
3.6 Differential Diagnosis. 113
3.7 Treatment. 114
3.7.1 Conservative Treatment. 114
3.7.2 Surgical Treatment. 122
3.7.3 Therapeutic Delivery. 127
3.7.4 Obstetric Treatment. 128
3.8 Prognosis. 128
3.8.1 General Considerations. 128
3.8.2 Primary Hyperparathyroidism. 129
3.8.3 Acute Fatty Liver of Pregnancy. 130
3.8.4 Hypertriglyceridemia. 130
3.8.5 Medications. 131
3.8.6 Alcohol. 131
3.8.7 Preeclampsia-Eclampsia. 131
References. 131
4 Nontraumatic Gastroduodenal Perforations. 145
4.1 Perforated Peptic Ulcers. 145
4.1.1 Peptic Ulcer in Pregnancy with General Considerations. 145
4.1.2 Perforated Peptic Ulcer. 155
4.2 Perforated Malignant Ulcer Carcinoma. 163
4.2.1 Gastric Cancer in Pregnancy. 163
4.2.2 Perforated Gastric Cancer in Pregnancy. 166
4.3 Non-peptic Ulcer Nontraumatic Gastric Perforations Ruptures. 167
4.3.1 Spontaneous Gastric Rupture. 167
4.3.2 Postoperative Gastric Perforation Rupture. 168
References. 169
5 Symptomatic Abdominal Wall Hernias. 179
5.1 Introduction. 179
5.2 Groin Hernia. 179
5.2.1 Incidence. 179
5.2.2 Etiopathogenesis and Risk Factors. 179
5.2.3 Clinical Presentation. 180
5.2.4 Diagnosis. 180
5.2.5 Differential Diagnosis. 180
5.2.6 Therapy. 187
5.2.7 Prognosis. 188
5.3 Umbilical Hernia. 188
5.3.1 Incidence. 188
5.3.2 Etiopathogenesis. 189
5.3.3 Clinical Presentation. 189
5.3.4 Diagnosis. 190
5.3.5 Differential Diagnosis. 190
5.3.6 Complications. 192
5.3.7 Therapy. 192
5.4 Postoperative Incisional Hernia. 195
5.4.1 Incidence. 195
5.4.2 Clinical Examination. 195
5.4.3 Diagnosis. 195
5.4.4 Therapy. 196
5.5 Parastomal Hernia. 198
5.5.1 Definition, Classification, and Types General Population. 198
5.5.2 Incidence. 198
5.5.3 Clinical Presentation. 199
5.5.4 Diagnosis. 199
5.5.5 Therapy. 199
References. 200
6 Symptomatic Diaphragmatic Hernia. 205
6.1 Etiology. 205
6.1.1 Acute Diaphragmatic Fatigue. 205
6.1.2 Diaphragmatic Hernia. 205
6.2 Clinical Presentation. 208
6.3 Diagnosis. 210
6.3.1 Chest Radiography. 210
6.3.2 Thoracic CT. 211
6.3.3 Thoracic MRI. 211
6.4 Therapy. 211
6.4.1 Conservative Treatment. 211
6.4.2 Surgical Treatment. 212
6.5 Prognosis. 217
6.5.1 Maternal Outcome. 217
6.5.2 Fetal Outcome. 217
6.5.3 Recurrent Hernia. 218
References. 218
7 Intestinal Obstruction. 221
7.1 Intestinal Obstruction in General. 221
7.1.1 Historical Perspective. 221
7.1.2 Incidence. 221
7.1.3 Clinical Presentation. 222
7.1.4 Differential Diagnosis. 222
7.1.5 Therapy. 227
7.1.6 Prognosis. 228
7.2 Intussusception. 228
7.2.1 General Considerations. 228
7.2.2 History. 229
7.2.3 Incidence. 229
7.2.4 Etiology. 230
7.2.5 Pathophysiology. 230
7.2.6 Clinical Presentation. 230
7.2.7 Diagnosis. 232
7.2.8 Therapy. 233
7.2.9 Prognosis. 234
7.3 Uterine Perforation After Surgical Abortion. 236
7.3.1 Introduction. 236
7.3.2 Incidence. 236
7.3.3 Risk Factors. 236
7.3.4 Mechanisms of Small Bowel Obstruction. 237
7.3.5 Clinical Presentation. 238
7.3.6 Diagnosis. 239
7.3.7 Therapy. 241
7.3.8 Prognosis. 242
7.4 Adhesions. 242
7.4.1 Incidence. 242
7.4.2 Pathophysiology. 242
7.4.3 Diagnosis. 243
7.4.4 Therapy. 243
7.5 Small Bowel Volvulus and Congenital Intestinal Malrotation. 243
7.5.1 Small Bowel Volvulus. 243
7.5.2 Congenital Intestinal Malrotation. 244
7.6 Carcinoma of the Colon and Rectum. 244
7.6.1 General Considerations of Colorectal Cancer in Pregnancy. 244
7.7 Stomal Obstruction. 249
7.7.1 Intussusception. 249
7.7.2 Stomal Obstruction. 250
7.8 Sigmoid Volvulus. 250
7.8.1 Incidence. 250
7.8.2 Pathophysiology. 250
7.8.3 Clinical Presentation. 250
7.8.4 Diagnosis. 251
7.8.5 Therapy. 251
7.8.6 Prognosis. 252
7.9 Cecal Volvulus. 252
7.9.1 General Considerations. 252
7.9.2 History. 252
7.9.3 Incidence. 253
7.9.4 Clinical Presentation. 253
7.9.5 Differential Diagnosis. 253
7.9.6 Diagnosis. 253
7.9.7 Prognosis. 254
7.10 Incarcerated Internal Hernia. 255
7.10.1 Post-Bariatric Surgery. 255
7.10.2 Spontaneous Incarcerated Internal Hernia. 258
7.11 Gastric Outlet Obstruction. 260
7.11.1 Heterotopic Pancreas. 260
7.12 Gynecologic Causes of Intestinal Obstruction. 261
7.12.1 Ovarian Teratoma. 261
7.12.2 Ectopic Pregnancy. 263
7.13 Intestinal Obstruction Caused by Normal Pregnancy. 264
7.13.1 History. 264
7.13.2 Incidence. 265
7.13.3 Pathophysiology. 265
7.13.4 Diagnosis. 266
7.13.5 Therapy. 266
References. 267
8 Acute Inflammatory Bowel Disease. 279
8.1 Acute Crohn s Disease. 279
8.1.1 Introduction. 279
8.1.2 Effect of Pregnancy on Crohn s Disease. 279
8.1.3 Clinical Presentation. 280
8.1.4 Diagnosis. 280
8.1.5 Differential Diagnosis. 280
8.1.6 Treatment. 280
8.1.7 Prognosis. 284
8.2 Acute Ulcerative Colitis. 287
8.2.1 Introduction. 287
8.2.2 Effect of Pregnancy on Ulcerative Colitis. 287
8.2.3 Incidence. 287
8.2.4 Diagnosis. 287
8.2.5 Treatment. 288
8.2.6 Prognosis. 291
References. 292
9 Spleen. 299
9.1 Splenic Rupture. 299
9.1.1 Definition and History. 299
9.1.2 Classification. 300
9.1.3 Clinical Presentation. 303
9.1.4 Differential Diagnosis. 304
9.1.5 Diagnosis. 304
9.1.6 Treatment. 305
9.1.7 Prognosis. 306
9.2 Ruptured Splenic Pregnancy. 307
9.2.1 Definition and Classification. 307
9.2.2 Incidence. 307
9.2.3 Pathophysiology. 307
9.2.4 Risk Factors. 307
9.2.5 Clinical Presentation. 307
9.2.6 Diagnosis. 308
9.2.7 Therapy. 308
9.3 Spontaneous Rupture of the Splenic Artery Aneurysm. 309
9.3.1 History. 309
9.3.2 Incidence. 310
9.3.3 Risk Factors. 311
9.3.4 Pathophysiology. 311
9.3.5 Clinical Presentation. 312
9.3.6 Diagnosis. 313
9.3.7 Differential Diagnosis. 314
9.3.8 Treatment. 314
9.3.9 Prognosis. 315
9.4 Spontaneous Splenic Vein Aneurysm Rupture. 315
9.4.1 History and Incidence. 315
9.4.2 Etiology. 315
9.4.3 Risk Factors. 316
9.4.4 Pathophysiology. 316
9.4.5 Clinical Presentation. 317
9.4.6 Diagnosis. 317
9.4.7 Therapy. 317
9.4.8 Prognosis. 318
9.5 Splenic Torsion. 318
9.5.1 History and Incidence. 318
9.5.2 Etiopathogenesis. 318
9.5.3 Clinical Presentation. 318
9.5.4 Diagnosis. 319
9.5.5 Therapy. 319
9.5.6 Prognosis. 319
References. 319
10 Abdominal Trauma. 325
10.1 General Considerations. 325
10.1.1 Incidence. 325
10.1.2 Risk Factors. 326
10.1.3 Prevention. 327
10.1.4 Anatomic and Physiological Changes
in Pregnancy Relevant to Trauma. 327
10.1.5 The Impact of Pregnancy on Trauma Mortality. 329
10.1.6 Major Obstetric Hemorrhage and Transfusion Protocol. 330
10.1.7 Prehospital Issues. 332
10.1.8 Anesthetic Perioperative Care. 334
10.2 Blunt Trauma. 337
10.2.1 Incidence. 337
10.2.2 Motor Vehicle Accidents. 339
10.2.3 Falls. 354
10.2.4 Social Violence. 355
10.2.5 Obstetric Consequences of Blunt Trauma. 356
10.2.6 Diagnosis. 362
10.2.7 Treatment. 368
10.2.8 Prognosis. 374
10.3 Penetrating Trauma. 377
10.3.1 Incidence. 377
10.3.2 Clinical Presentation. 377
10.3.3 Diagnosis. 378
10.3.4 Treatment. 381
10.3.5 Prognosis. 388
References. 389
11 Miscellaneous Conditions. 401
11.1 Small Bowel Perforation. 401
11.1.1 Intestinal Perforation Due to Intestinal Endometriosis. 401
11.1.2 Spontaneous Small Bowel Perforation. 403
11.2 Perforation of the Colon and Rectum. 403
11.2.1 Colorectal Carcinoma in Pregnancy. 403
11.2.2 Spontaneous Colorectal Perforation. 408
11.2.3 Bowel Perforation Secondary to Illegally Induced Abortion. 409
11.2.4 Treatment. 410
11.2.5 Prognosis. 410
11.3 Spontaneous Liver Rupture. 411
11.3.1 Incidence. 411
11.3.2 History. 411
11.3.3 Etiopathogenesis. 412
11.3.4 Clinical Presentation. 413
11.3.5 Differential Diagnosis. 414
11.3.6 Diagnosis. 414
11.3.7 Treatment. 414
11.3.8 Prognosis. 416
11.4 Peptic Ulcer Bleeding. 417
11.4.1 Introduction. 417
11.4.2 Incidence. 417
11.4.3 Risk Factors. 418
11.4.4 Diagnosis. 418
11.4.5 Treatment. 418
11.4.6 Prognosis. 418
11.5 Mesenteric Ischemia. 419
11.5.1 Mesenteric Vein Thrombosis. 419
11.5.2 Portal Vein Thrombosis. 424
11.6 Inferior Epigastric Artery Bleeding. 426
11.6.1 Anatomy. 426
11.6.2 Mechanisms of Injury. 426
11.6.3 Incidence. 426
11.6.4 Clinical Presentation. 426
11.6.5 Differential Diagnosis. 427
11.6.6 Diagnosis. 427
11.6.7 Treatment. 427
11.6.8 Spontaneous Rectus Hematoma. 428
11.7 Omental Infarction. 431
11.7.1 Incidence. 431
11.7.2 Etiology. 432
11.7.3 Clinical Presentation. 432
11.7.4 Differential Diagnosis. 432
11.7.5 Diagnosis. 433
11.7.6 Therapy. 433
11.8 Gastrointestinal Genital Communications. 433
11.8.1 Introduction. 433
11.8.2 Incidence. 433
11.8.3 Etiology. 434
11.8.4 Pathogenesis. 434
11.8.5 Prevention. 435
11.8.6 Management. 435
References. 435
Part II Gynecology
12 Adnexal Torsion. 447
12.1 General Considerations. 447
12.1.1 Introduction. 447
12.2 Incidence. 447
12.3 Risk Factors. 448
12.3.1 Assisted Reproductive Technologies. 448
12.3.2 Pregnancy. 448
12.3.3 Ovarian Tumors. 448
12.3.4 Anatomic Variations of Adnexa. 449
12.4 Clinical Presentation. 449
12.5 Diagnosis and Differential Diagnosis. 449
12.5.1 Differential Diagnosis. 449
12.5.2 Diagnosis. 450
12.6 Treatment. 451
12.6.1 Time Between Hospital Admission and Surgery. 451
12.6.2 Procedures. 452
12.6.3 Operative Technique. 453
12.6.4 Pathology. 456
12.6.5 Special Considerations. 456
12.6.6 Perioperative Management. 457
12.7 Prognosis. 457
12.7.1 Risk of Recurrence. 457
References. 458
13 Isolated Torsion of the Fallopian Tube. 461
13.1 Incidence. 461
13.2 Pathophysiology and Risk Factors. 461
13.2.1 Pathophysiology. 461
13.2.2 Risk Factors. 461
13.3 Clinical Presentation. 462
13.4 Diagnosis and Differential Diagnosis. 462
13.4.1 Differential Diagnosis. 462
13.4.2 Diagnosis. 462
13.5 Treatment and Prognosis. 463
13.5.1 Treatment. 463
13.5.2 Prognosis. 463
References. 463
14 Ruptured Bleeding Ovarian Cysts Tumors. 465
14.1 Incidence. 465
14.1.1 Ovarian Cysts. 465
14.1.2 Ovarian Teratoma. 466
14.2 Clinical Presentation. 466
14.3 Diagnosis. 467
14.3.1 Laboratory Findings. 467
14.3.2 Abdominal Ultrasound. 467
14.4 Treatment. 467
14.4.1 Introduction. 467
14.4.2 Conservative Treatment. 468
14.4.3 Operative Treatment. 468
14.5 Prognosis. 470
14.5.1 Maternal Outcome. 470
14.5.2 Fetal Outcome. 471
References. 471
15 Ruptured Ectopic Pregnancy. 473
15.1 Ectopic Pregnancy in General. 473
15.1.1 Incidence. 473
15.1.2 Risk Factors. 473
15.1.3 Classification. 473
15.1.4 Clinical Presentation. 474
15.1.5 Diagnosis. 477
15.1.6 Treatment. 479
15.1.7 Prognosis. 482
15.2 Ruptured Cornual Pregnancy. 482
15.2.1 Definition. 482
15.2.2 Incidence and Pathophysiology. 482
15.2.3 Clinical Examination. 483
15.2.4 Diagnosis. 483
15.2.5 Treatment. 483
15.2.6 Prognosis. 485
15.3 Abdominal Pregnancy. 485
15.3.1 Classification. 485
15.3.2 Incidence. 485
15.3.3 Risk Factors. 486
15.3.4 Clinical Presentation. 486
15.3.5 Diagnosis. 486
15.3.6 Treatment. 487
15.3.7 Prognosis. 490
References. 490
16 Spontaneous Uterine Rupture. 495
16.1 History. 495
16.2 Incidence. 495
16.2.1 Developed Undeveloped Country. 495
16.2.2 Decade Dependency. 495
16.3 Risk Factors. 496
16.3.1 Scarred Uterus Previous Cesarean Delivery. 496
16.3.2 Multiple Cesarean Deliveries. 502
16.3.3 Unscarred Uterus. 504
16.4 Prevention. 507
16.5 Mechanisms and Classification. 507
16.5.1 Definition. 507
16.5.2 Classification. 508
16.5.3 Pathophysiology. 509
16.6 Clinical Presentation. 510
16.6.1 Symptoms and Signs. 510
16.6.2 Physical Examination. 512
16.7 Diagnosis. 512
16.7.1 Transvaginal Transabdominal Ultrasound. 512
16.7.2 Abdominal CT. 513
16.7.3 Magnetic Resonance Imaging. 513
16.7.4 Uterine Tone Monitoring. 513
16.8 Treatment. 516
16.8.1 Perioperative Management. 516
16.8.2 Operative Treatment. 516
16.9 Prognosis. 518
16.9.1 Maternal Outcome. 519
16.9.2 Fetal Outcome. 519
References. 520
17 Torsion of the Gravid Uterus. 529
17.1 History and Incidence. 529
17.1.1 History. 529
17.1.2 Incidence. 529
17.2 Etiopathogenesis. 529
17.3 Clinical Presentation. 531
17.3.1 Symptomatology. 531
17.3.2 Physical Examination. 531
17.4 Diagnosis. 532
17.5 Treatment. 532
17.5.1 Surgical Treatment of Uterine Torsion. 532
17.5.2 Obstetric Management. 533
17.6 Prognosis. 533
17.6.1 Maternal Outcome. 533
17.6.2 Perinatal Outcome. 533
References. 534
18 Degenerating Uterine Myomas. 535
18.1 Classification and Histopathological Features. 535
18.1.1 Considerations in the General Female Population. 535
18.1.2 Classification. 535
18.2 Incidence. 536
18.2.1 Natural History of the Disease. 536
18.3 Clinical Presentation. 536
18.3.1 Physical Examination. 536
18.4 Diagnosis. 536
18.5 Treatment. 537
18.5.1 Emergent Presentation. 537
18.5.2 Elective Presentation. 538
18.6 Prognosis. 538
18.6.1 Maternal Outcome. 538
18.6.2 Neonatal Outcome. 538
References. 538
19 Pelvic Inflammatory Disease and Tubo-ovarian Abscess. 541
19.1 Considerations in General Female Population. 541
19.1.1 Tubo-ovarian Abscess. 541
19.1.2 Ovarian Abscess. 543
19.2 Incidence. 543
19.2.1 Tubo-ovarian Abscess. 543
19.2.2 Ovarian Abscess. 543
19.2.3 Intramyometrial Abscess. 543
19.3 Etiopathogenesis. 544
19.3.1 Tubo-ovarian Abscess. 544
19.3.2 Ovarian Abscess. 546
19.3.3 Intramyometrial Abscess. 546
19.4 Microbiology. 547
19.4.1 Ovarian Abscess. 547
19.5 Clinical Presentation. 547
19.5.1 Tubo-ovarian Abscess. 547
19.5.2 Ovarian Abscess. 548
19.6 Diagnosis and Differential Diagnosis. 548
19.6.1 Differential Diagnosis. 548
19.6.2 General Female Population. 548
19.6.3 Pregnant Patients. 549
19.7 Prevention of Infection. 550
19.7.1 Preprocedural Elimination of Endometriosis. 550
19.7.2 Procedural Vaginal Antisepsis. 550
19.7.3 Prophylactic Antibiotics Antifungal Agents. 550
19.8 Treatment. 550
19.8.1 Medical Therapy. 550
19.8.2 Surgical Therapy. 551
19.9 Prognosis. 551
19.9.1 Tubo-ovarian Abscess. 551
19.9.2 Ovarian Abscess. 553
References. 553
Index. 557
1 Acute Appendicitis. 3
1.1 History. 3
1.2 Incidence, Etiology, and Pathogenesis. 3
1.3 History Taking and Clinical Examination. 5
1.4 Examination. 7
1.4.1 Scoring Systems. 8
1.5 Differential Diagnosis. 9
1.5.1 Round Ligament Pain Syndrome. 9
1.5.2 Ovarian Vein Thrombosis. 10
1.5.3 Pathologic Conditions Associated with the Puerperium. 10
1.6 Diagnosis. 11
1.6.1 Introduction. 11
1.6.2 Laboratory Findings. 12
1.6.3 Transvaginal Ultrasound. 12
1.6.4 Graded Abdominal Ultrasound. 13
1.6.5 Magnetic Resonance Imaging. 13
1.6.6 Computed Tomography CT Scan. 15
1.6.7 Chest Radiograph. 16
1.7 Negative Appendectomy. 16
1.7.1 Incidence. 16
1.7.2 Indications for Appendectomy. 17
1.7.3 Perinatal Outcome. 18
1.8 Management. 18
1.8.1 Anesthetic Considerations. 18
1.8.2 Open Appendectomy. 18
1.8.3 Laparoscopic Appendectomy. 19
1.8.4 Conversion from Laparoscopic to Open Approach. 22
1.8.5 Perioperative Considerations. 22
1.9 Specific Considerations. 26
1.9.1 Incidental Meckel s Diverticulum. 26
1.9.2 Acute Appendicitis and Ectopic Heterotopic Pregnancy. 27
1.9.3 Acute Appendicitis in Patients with In Vitro Fertilization and Embryo Transfer. 27
1.9.4 Acute Appendicitis and Sickle Cell Disease. 30
1.9.5 Appendiceal Endometriosis Presenting as Acute Appendicitis. 30
1.9.6 Surgical Considerations in the Postpartum Period. 31
1.10 Prognosis. 32
1.10.1 Perforation Rate. 32
1.10.2 Fetal Outcome. 33
1.10.3 Maternal Outcome. 34
References. 34
2 Acute Biliary Tract Diseases. 45
2.1 Acute Cholecystitis Biliary Colic. 45
2.1.1 History. 45
2.1.2 Incidence. 45
2.1.3 Risk Factors. 46
2.1.4 Pathophysiology. 47
2.1.5 Clinical Presentation. 50
2.1.6 Differential Diagnosis. 51
2.1.7 Diagnosis. 52
2.1.8 Treatment. 53
2.1.9 Prognosis. 69
2.2 Common Bile Duct Stones, Cholangitis, and Biliary Pancreatitis. 70
2.2.1 Incidence. 70
2.2.2 History. 70
2.2.3 Examination. 70
2.2.4 Differential Diagnosis. 70
2.2.5 Diagnosis. 72
2.2.6 Therapy. 75
2.2.7 Prognosis. 78
2.3 Symptomatic Choledochal Cysts. 78
2.3.1 History. 78
2.3.2 Incidence. 78
2.3.3 Clinical Presentation. 78
2.3.4 Diagnosis. 79
2.3.5 Therapy. 79
References. 80
3 Acute Pancreatitis. 91
3.1 History. 91
3.2 Incidence. 91
3.2.1 Incidence in General Population. 91
3.2.2 Incidence in Pregnancy. 91
3.3 Etiopathogenesis. 93
3.3.1 Introduction. 93
3.3.2 Primary Hyperparathyroidism. 94
3.3.3 Acute Fatty Liver of Pregnancy. 97
3.3.4 Hyperlipidemia Hypertriglyceridemia. 97
3.3.5 Alcohol. 102
3.3.6 Medications. 103
3.3.7 In Vitro Fertilization. 104
3.3.8 Postpartum Acute Pancreatitis. 104
3.3.9 Preeclampsia-Eclampsia. 105
3.3.10 Placental Abruption. 105
3.4 Clinical Features. 105
3.4.1 History Taking. 105
3.4.2 Clinical Presentation. 105
3.4.3 Physical Examination. 107
3.5 Diagnosis. 108
3.5.1 Laboratory Findings. 108
3.5.2 Imaging Methods. 111
3.6 Differential Diagnosis. 113
3.7 Treatment. 114
3.7.1 Conservative Treatment. 114
3.7.2 Surgical Treatment. 122
3.7.3 Therapeutic Delivery. 127
3.7.4 Obstetric Treatment. 128
3.8 Prognosis. 128
3.8.1 General Considerations. 128
3.8.2 Primary Hyperparathyroidism. 129
3.8.3 Acute Fatty Liver of Pregnancy. 130
3.8.4 Hypertriglyceridemia. 130
3.8.5 Medications. 131
3.8.6 Alcohol. 131
3.8.7 Preeclampsia-Eclampsia. 131
References. 131
4 Nontraumatic Gastroduodenal Perforations. 145
4.1 Perforated Peptic Ulcers. 145
4.1.1 Peptic Ulcer in Pregnancy with General Considerations. 145
4.1.2 Perforated Peptic Ulcer. 155
4.2 Perforated Malignant Ulcer Carcinoma. 163
4.2.1 Gastric Cancer in Pregnancy. 163
4.2.2 Perforated Gastric Cancer in Pregnancy. 166
4.3 Non-peptic Ulcer Nontraumatic Gastric Perforations Ruptures. 167
4.3.1 Spontaneous Gastric Rupture. 167
4.3.2 Postoperative Gastric Perforation Rupture. 168
References. 169
5 Symptomatic Abdominal Wall Hernias. 179
5.1 Introduction. 179
5.2 Groin Hernia. 179
5.2.1 Incidence. 179
5.2.2 Etiopathogenesis and Risk Factors. 179
5.2.3 Clinical Presentation. 180
5.2.4 Diagnosis. 180
5.2.5 Differential Diagnosis. 180
5.2.6 Therapy. 187
5.2.7 Prognosis. 188
5.3 Umbilical Hernia. 188
5.3.1 Incidence. 188
5.3.2 Etiopathogenesis. 189
5.3.3 Clinical Presentation. 189
5.3.4 Diagnosis. 190
5.3.5 Differential Diagnosis. 190
5.3.6 Complications. 192
5.3.7 Therapy. 192
5.4 Postoperative Incisional Hernia. 195
5.4.1 Incidence. 195
5.4.2 Clinical Examination. 195
5.4.3 Diagnosis. 195
5.4.4 Therapy. 196
5.5 Parastomal Hernia. 198
5.5.1 Definition, Classification, and Types General Population. 198
5.5.2 Incidence. 198
5.5.3 Clinical Presentation. 199
5.5.4 Diagnosis. 199
5.5.5 Therapy. 199
References. 200
6 Symptomatic Diaphragmatic Hernia. 205
6.1 Etiology. 205
6.1.1 Acute Diaphragmatic Fatigue. 205
6.1.2 Diaphragmatic Hernia. 205
6.2 Clinical Presentation. 208
6.3 Diagnosis. 210
6.3.1 Chest Radiography. 210
6.3.2 Thoracic CT. 211
6.3.3 Thoracic MRI. 211
6.4 Therapy. 211
6.4.1 Conservative Treatment. 211
6.4.2 Surgical Treatment. 212
6.5 Prognosis. 217
6.5.1 Maternal Outcome. 217
6.5.2 Fetal Outcome. 217
6.5.3 Recurrent Hernia. 218
References. 218
7 Intestinal Obstruction. 221
7.1 Intestinal Obstruction in General. 221
7.1.1 Historical Perspective. 221
7.1.2 Incidence. 221
7.1.3 Clinical Presentation. 222
7.1.4 Differential Diagnosis. 222
7.1.5 Therapy. 227
7.1.6 Prognosis. 228
7.2 Intussusception. 228
7.2.1 General Considerations. 228
7.2.2 History. 229
7.2.3 Incidence. 229
7.2.4 Etiology. 230
7.2.5 Pathophysiology. 230
7.2.6 Clinical Presentation. 230
7.2.7 Diagnosis. 232
7.2.8 Therapy. 233
7.2.9 Prognosis. 234
7.3 Uterine Perforation After Surgical Abortion. 236
7.3.1 Introduction. 236
7.3.2 Incidence. 236
7.3.3 Risk Factors. 236
7.3.4 Mechanisms of Small Bowel Obstruction. 237
7.3.5 Clinical Presentation. 238
7.3.6 Diagnosis. 239
7.3.7 Therapy. 241
7.3.8 Prognosis. 242
7.4 Adhesions. 242
7.4.1 Incidence. 242
7.4.2 Pathophysiology. 242
7.4.3 Diagnosis. 243
7.4.4 Therapy. 243
7.5 Small Bowel Volvulus and Congenital Intestinal Malrotation. 243
7.5.1 Small Bowel Volvulus. 243
7.5.2 Congenital Intestinal Malrotation. 244
7.6 Carcinoma of the Colon and Rectum. 244
7.6.1 General Considerations of Colorectal Cancer in Pregnancy. 244
7.7 Stomal Obstruction. 249
7.7.1 Intussusception. 249
7.7.2 Stomal Obstruction. 250
7.8 Sigmoid Volvulus. 250
7.8.1 Incidence. 250
7.8.2 Pathophysiology. 250
7.8.3 Clinical Presentation. 250
7.8.4 Diagnosis. 251
7.8.5 Therapy. 251
7.8.6 Prognosis. 252
7.9 Cecal Volvulus. 252
7.9.1 General Considerations. 252
7.9.2 History. 252
7.9.3 Incidence. 253
7.9.4 Clinical Presentation. 253
7.9.5 Differential Diagnosis. 253
7.9.6 Diagnosis. 253
7.9.7 Prognosis. 254
7.10 Incarcerated Internal Hernia. 255
7.10.1 Post-Bariatric Surgery. 255
7.10.2 Spontaneous Incarcerated Internal Hernia. 258
7.11 Gastric Outlet Obstruction. 260
7.11.1 Heterotopic Pancreas. 260
7.12 Gynecologic Causes of Intestinal Obstruction. 261
7.12.1 Ovarian Teratoma. 261
7.12.2 Ectopic Pregnancy. 263
7.13 Intestinal Obstruction Caused by Normal Pregnancy. 264
7.13.1 History. 264
7.13.2 Incidence. 265
7.13.3 Pathophysiology. 265
7.13.4 Diagnosis. 266
7.13.5 Therapy. 266
References. 267
8 Acute Inflammatory Bowel Disease. 279
8.1 Acute Crohn s Disease. 279
8.1.1 Introduction. 279
8.1.2 Effect of Pregnancy on Crohn s Disease. 279
8.1.3 Clinical Presentation. 280
8.1.4 Diagnosis. 280
8.1.5 Differential Diagnosis. 280
8.1.6 Treatment. 280
8.1.7 Prognosis. 284
8.2 Acute Ulcerative Colitis. 287
8.2.1 Introduction. 287
8.2.2 Effect of Pregnancy on Ulcerative Colitis. 287
8.2.3 Incidence. 287
8.2.4 Diagnosis. 287
8.2.5 Treatment. 288
8.2.6 Prognosis. 291
References. 292
9 Spleen. 299
9.1 Splenic Rupture. 299
9.1.1 Definition and History. 299
9.1.2 Classification. 300
9.1.3 Clinical Presentation. 303
9.1.4 Differential Diagnosis. 304
9.1.5 Diagnosis. 304
9.1.6 Treatment. 305
9.1.7 Prognosis. 306
9.2 Ruptured Splenic Pregnancy. 307
9.2.1 Definition and Classification. 307
9.2.2 Incidence. 307
9.2.3 Pathophysiology. 307
9.2.4 Risk Factors. 307
9.2.5 Clinical Presentation. 307
9.2.6 Diagnosis. 308
9.2.7 Therapy. 308
9.3 Spontaneous Rupture of the Splenic Artery Aneurysm. 309
9.3.1 History. 309
9.3.2 Incidence. 310
9.3.3 Risk Factors. 311
9.3.4 Pathophysiology. 311
9.3.5 Clinical Presentation. 312
9.3.6 Diagnosis. 313
9.3.7 Differential Diagnosis. 314
9.3.8 Treatment. 314
9.3.9 Prognosis. 315
9.4 Spontaneous Splenic Vein Aneurysm Rupture. 315
9.4.1 History and Incidence. 315
9.4.2 Etiology. 315
9.4.3 Risk Factors. 316
9.4.4 Pathophysiology. 316
9.4.5 Clinical Presentation. 317
9.4.6 Diagnosis. 317
9.4.7 Therapy. 317
9.4.8 Prognosis. 318
9.5 Splenic Torsion. 318
9.5.1 History and Incidence. 318
9.5.2 Etiopathogenesis. 318
9.5.3 Clinical Presentation. 318
9.5.4 Diagnosis. 319
9.5.5 Therapy. 319
9.5.6 Prognosis. 319
References. 319
10 Abdominal Trauma. 325
10.1 General Considerations. 325
10.1.1 Incidence. 325
10.1.2 Risk Factors. 326
10.1.3 Prevention. 327
10.1.4 Anatomic and Physiological Changes
in Pregnancy Relevant to Trauma. 327
10.1.5 The Impact of Pregnancy on Trauma Mortality. 329
10.1.6 Major Obstetric Hemorrhage and Transfusion Protocol. 330
10.1.7 Prehospital Issues. 332
10.1.8 Anesthetic Perioperative Care. 334
10.2 Blunt Trauma. 337
10.2.1 Incidence. 337
10.2.2 Motor Vehicle Accidents. 339
10.2.3 Falls. 354
10.2.4 Social Violence. 355
10.2.5 Obstetric Consequences of Blunt Trauma. 356
10.2.6 Diagnosis. 362
10.2.7 Treatment. 368
10.2.8 Prognosis. 374
10.3 Penetrating Trauma. 377
10.3.1 Incidence. 377
10.3.2 Clinical Presentation. 377
10.3.3 Diagnosis. 378
10.3.4 Treatment. 381
10.3.5 Prognosis. 388
References. 389
11 Miscellaneous Conditions. 401
11.1 Small Bowel Perforation. 401
11.1.1 Intestinal Perforation Due to Intestinal Endometriosis. 401
11.1.2 Spontaneous Small Bowel Perforation. 403
11.2 Perforation of the Colon and Rectum. 403
11.2.1 Colorectal Carcinoma in Pregnancy. 403
11.2.2 Spontaneous Colorectal Perforation. 408
11.2.3 Bowel Perforation Secondary to Illegally Induced Abortion. 409
11.2.4 Treatment. 410
11.2.5 Prognosis. 410
11.3 Spontaneous Liver Rupture. 411
11.3.1 Incidence. 411
11.3.2 History. 411
11.3.3 Etiopathogenesis. 412
11.3.4 Clinical Presentation. 413
11.3.5 Differential Diagnosis. 414
11.3.6 Diagnosis. 414
11.3.7 Treatment. 414
11.3.8 Prognosis. 416
11.4 Peptic Ulcer Bleeding. 417
11.4.1 Introduction. 417
11.4.2 Incidence. 417
11.4.3 Risk Factors. 418
11.4.4 Diagnosis. 418
11.4.5 Treatment. 418
11.4.6 Prognosis. 418
11.5 Mesenteric Ischemia. 419
11.5.1 Mesenteric Vein Thrombosis. 419
11.5.2 Portal Vein Thrombosis. 424
11.6 Inferior Epigastric Artery Bleeding. 426
11.6.1 Anatomy. 426
11.6.2 Mechanisms of Injury. 426
11.6.3 Incidence. 426
11.6.4 Clinical Presentation. 426
11.6.5 Differential Diagnosis. 427
11.6.6 Diagnosis. 427
11.6.7 Treatment. 427
11.6.8 Spontaneous Rectus Hematoma. 428
11.7 Omental Infarction. 431
11.7.1 Incidence. 431
11.7.2 Etiology. 432
11.7.3 Clinical Presentation. 432
11.7.4 Differential Diagnosis. 432
11.7.5 Diagnosis. 433
11.7.6 Therapy. 433
11.8 Gastrointestinal Genital Communications. 433
11.8.1 Introduction. 433
11.8.2 Incidence. 433
11.8.3 Etiology. 434
11.8.4 Pathogenesis. 434
11.8.5 Prevention. 435
11.8.6 Management. 435
References. 435
Part II Gynecology
12 Adnexal Torsion. 447
12.1 General Considerations. 447
12.1.1 Introduction. 447
12.2 Incidence. 447
12.3 Risk Factors. 448
12.3.1 Assisted Reproductive Technologies. 448
12.3.2 Pregnancy. 448
12.3.3 Ovarian Tumors. 448
12.3.4 Anatomic Variations of Adnexa. 449
12.4 Clinical Presentation. 449
12.5 Diagnosis and Differential Diagnosis. 449
12.5.1 Differential Diagnosis. 449
12.5.2 Diagnosis. 450
12.6 Treatment. 451
12.6.1 Time Between Hospital Admission and Surgery. 451
12.6.2 Procedures. 452
12.6.3 Operative Technique. 453
12.6.4 Pathology. 456
12.6.5 Special Considerations. 456
12.6.6 Perioperative Management. 457
12.7 Prognosis. 457
12.7.1 Risk of Recurrence. 457
References. 458
13 Isolated Torsion of the Fallopian Tube. 461
13.1 Incidence. 461
13.2 Pathophysiology and Risk Factors. 461
13.2.1 Pathophysiology. 461
13.2.2 Risk Factors. 461
13.3 Clinical Presentation. 462
13.4 Diagnosis and Differential Diagnosis. 462
13.4.1 Differential Diagnosis. 462
13.4.2 Diagnosis. 462
13.5 Treatment and Prognosis. 463
13.5.1 Treatment. 463
13.5.2 Prognosis. 463
References. 463
14 Ruptured Bleeding Ovarian Cysts Tumors. 465
14.1 Incidence. 465
14.1.1 Ovarian Cysts. 465
14.1.2 Ovarian Teratoma. 466
14.2 Clinical Presentation. 466
14.3 Diagnosis. 467
14.3.1 Laboratory Findings. 467
14.3.2 Abdominal Ultrasound. 467
14.4 Treatment. 467
14.4.1 Introduction. 467
14.4.2 Conservative Treatment. 468
14.4.3 Operative Treatment. 468
14.5 Prognosis. 470
14.5.1 Maternal Outcome. 470
14.5.2 Fetal Outcome. 471
References. 471
15 Ruptured Ectopic Pregnancy. 473
15.1 Ectopic Pregnancy in General. 473
15.1.1 Incidence. 473
15.1.2 Risk Factors. 473
15.1.3 Classification. 473
15.1.4 Clinical Presentation. 474
15.1.5 Diagnosis. 477
15.1.6 Treatment. 479
15.1.7 Prognosis. 482
15.2 Ruptured Cornual Pregnancy. 482
15.2.1 Definition. 482
15.2.2 Incidence and Pathophysiology. 482
15.2.3 Clinical Examination. 483
15.2.4 Diagnosis. 483
15.2.5 Treatment. 483
15.2.6 Prognosis. 485
15.3 Abdominal Pregnancy. 485
15.3.1 Classification. 485
15.3.2 Incidence. 485
15.3.3 Risk Factors. 486
15.3.4 Clinical Presentation. 486
15.3.5 Diagnosis. 486
15.3.6 Treatment. 487
15.3.7 Prognosis. 490
References. 490
16 Spontaneous Uterine Rupture. 495
16.1 History. 495
16.2 Incidence. 495
16.2.1 Developed Undeveloped Country. 495
16.2.2 Decade Dependency. 495
16.3 Risk Factors. 496
16.3.1 Scarred Uterus Previous Cesarean Delivery. 496
16.3.2 Multiple Cesarean Deliveries. 502
16.3.3 Unscarred Uterus. 504
16.4 Prevention. 507
16.5 Mechanisms and Classification. 507
16.5.1 Definition. 507
16.5.2 Classification. 508
16.5.3 Pathophysiology. 509
16.6 Clinical Presentation. 510
16.6.1 Symptoms and Signs. 510
16.6.2 Physical Examination. 512
16.7 Diagnosis. 512
16.7.1 Transvaginal Transabdominal Ultrasound. 512
16.7.2 Abdominal CT. 513
16.7.3 Magnetic Resonance Imaging. 513
16.7.4 Uterine Tone Monitoring. 513
16.8 Treatment. 516
16.8.1 Perioperative Management. 516
16.8.2 Operative Treatment. 516
16.9 Prognosis. 518
16.9.1 Maternal Outcome. 519
16.9.2 Fetal Outcome. 519
References. 520
17 Torsion of the Gravid Uterus. 529
17.1 History and Incidence. 529
17.1.1 History. 529
17.1.2 Incidence. 529
17.2 Etiopathogenesis. 529
17.3 Clinical Presentation. 531
17.3.1 Symptomatology. 531
17.3.2 Physical Examination. 531
17.4 Diagnosis. 532
17.5 Treatment. 532
17.5.1 Surgical Treatment of Uterine Torsion. 532
17.5.2 Obstetric Management. 533
17.6 Prognosis. 533
17.6.1 Maternal Outcome. 533
17.6.2 Perinatal Outcome. 533
References. 534
18 Degenerating Uterine Myomas. 535
18.1 Classification and Histopathological Features. 535
18.1.1 Considerations in the General Female Population. 535
18.1.2 Classification. 535
18.2 Incidence. 536
18.2.1 Natural History of the Disease. 536
18.3 Clinical Presentation. 536
18.3.1 Physical Examination. 536
18.4 Diagnosis. 536
18.5 Treatment. 537
18.5.1 Emergent Presentation. 537
18.5.2 Elective Presentation. 538
18.6 Prognosis. 538
18.6.1 Maternal Outcome. 538
18.6.2 Neonatal Outcome. 538
References. 538
19 Pelvic Inflammatory Disease and Tubo-ovarian Abscess. 541
19.1 Considerations in General Female Population. 541
19.1.1 Tubo-ovarian Abscess. 541
19.1.2 Ovarian Abscess. 543
19.2 Incidence. 543
19.2.1 Tubo-ovarian Abscess. 543
19.2.2 Ovarian Abscess. 543
19.2.3 Intramyometrial Abscess. 543
19.3 Etiopathogenesis. 544
19.3.1 Tubo-ovarian Abscess. 544
19.3.2 Ovarian Abscess. 546
19.3.3 Intramyometrial Abscess. 546
19.4 Microbiology. 547
19.4.1 Ovarian Abscess. 547
19.5 Clinical Presentation. 547
19.5.1 Tubo-ovarian Abscess. 547
19.5.2 Ovarian Abscess. 548
19.6 Diagnosis and Differential Diagnosis. 548
19.6.1 Differential Diagnosis. 548
19.6.2 General Female Population. 548
19.6.3 Pregnant Patients. 549
19.7 Prevention of Infection. 550
19.7.1 Preprocedural Elimination of Endometriosis. 550
19.7.2 Procedural Vaginal Antisepsis. 550
19.7.3 Prophylactic Antibiotics Antifungal Agents. 550
19.8 Treatment. 550
19.8.1 Medical Therapy. 550
19.8.2 Surgical Therapy. 551
19.9 Prognosis. 551
19.9.1 Tubo-ovarian Abscess. 551
19.9.2 Ovarian Abscess. 553
References. 553
Index. 557