Оригинальные и переводные издания на русском языке, выпущенные в России в дореволюционный и советский период

Acute Abdomen During Pregnancy

Автор: Augustin G.
Издательство: Springer
Город: Zagreb
Издание: 2
Страниц: 853
Аннотация:

This is the second edition of a well-received book that reflects the state of the art in diagnosis and treatment of acute abdominal disorders in the pregnant patient. It addresses a wide range of conditions, whether associated with or incidental to pregnancy, ranging from very rare to more common ones, such as acute appendicitis and acute cholecystitis. It offers an update on recommendations, guidelines and scenarios to provide fundamental support for all clinicians who might encounter such cases. The book highlights the importance of a rapid diagnosis to avoid serious consequences for both the mother and the fetus. Furthermore, it sheds light on the different imaging modalities of rare pathologies that can occur during pregnancy, helping clinicians and radiologists to better define underlying cases.
This new edition has been almost completely rewritten, and includes an additional section focusing on urologic emergencies, preterm labor and intra-abdominal pressure, as well as new figures and tables.
It is equally valuable for general and abdominal surgeons, gynecologists and obstetricians, as well as emergency physicians, who may be the first specialists to have clinical contact with this group of patients.



Acute Abdomen During Pregnancy. 2nd Edition

Part I Surgery
1 Acute Appendicitis…………………………………….. 3
1.1 Historical Perspective……………………………… 3
1.2 Incidence…………………………………………. 4
1.3 Risk Factors………………………………………. 5
1.3.1 Age and Multiple Pregnancies………………….. 5
1.3.2 Trimester…………………………………… 5
1.3.3 Other………………………………………. 6
1.4 Pathogenesis………………………………………. 7
1.4.1 Immunologic Changes………………………….. 7
1.4.2 Anatomic/Physiological Changes………………… 7
1.4.3 Recurrent/Chronic Appendicitis………………… 8
1.4.4 Female Sex Hormones………………………….. 8
1.5 Clinical Presentation………………………………. 8
1.5.1 Medical History……………………………… 8
1.5.2 Physical Examination………………………… 11
1.6 Differential Diagnosis…………………………….. 12
1.6.1 Round Ligament Pain/Syndrome…………………. 12
1.6.2 Stump Appendicitis………………………….. 13
1.6.3 Meckel’s Diverticulitis……………………… 13
1.6.4 Crohn’s Disease…………………………….. 13
1.6.5 Urolithiasis/Urinary Tract Infection………….. 13
1.6.6 Vomiting of Pregnancy……………………….. 13
1.6.7 Fitz-Hugh-Curtis Syndrome……………………. 14
1.6.8 Puerperium-Associated Diseases……………….. 14
1.7 Diagnosis………………………………………… 15
1.7.1 Laboratory Findings…………………………. 16
1.7.2 Diagnostic Scoring Systems…………………… 17
1.7.3 Transabdominal Ultrasound……………………. 18
1.7.4 Transvaginal Ultrasound……………………… 18
1.7.5 Abdominal MRI………………………………. 20
1.7.6 Abdominal CT……………………………….. 21
1.8 Treatment………………………………………… 23
1.8.1 Conservative Treatment………………………. 24
1.8.2 Open Appendectomy…………………………… 24
1.8.3 Laparoscopic Appendectomy……………………… 26
1.8.4 Perioperative Considerations…………………… 28
1.9 Specific Considerations…………………………… 30
1.9.1 Normal Appendix………………………………. 30
1.9.2 Incidental Meckel’s Diverticulum……………….. 32
1.9.3 Ectopic/Heterotopic Pregnancy………………….. 32
1.9.4 Assisted Reproductive Techniques……………….. 33
1.9.5 Sickle Cell Disease…………………………… 34
1.9.6 Appendiceal Endometriosis/Deciduosis…………. 35
1.9.7 Appendiceal Carcinoid………………………. 36
1.9.8 Perityphlitic Abscess………………………. 37
1.9.9 Puerperium…………………………………… 37
1.10 Prognosis………………………………………. 37
1.10.1 Conservative Treatment……………………….. 37
1.10.2 Perforation Rate…………………………….. 38
1.10.3 Maternal Outcome…………………………….. 38
1.10.4 Fetal Outcome……………………………….. 40
References…………………………………………… 43
2 Acute Biliary Tract Disease……………………………. 55
2.1 Acute Cholecystitis/Biliary Colic…………………… 55
2.1.1 Historical Perspective………………………… 55
2.1.2 Incidence……………………………………. 55
2.1.3 Risk Factors…………………………………. 56
2.1.4 Pathogenesis…………………………………. 58
2.1.5 Clinical Presentation…………………………. 61
2.1.6 Differential Diagnosis………………………… 62
2.1.7 Diagnosis……………………………………. 63
2.1.8 Treatment……………………………………. 65
2.1.9 Prognosis……………………………………. 77
2.2 Common Bile Duct Stones and Acute Cholangitis………….. 77
2.2.1 Incidence……………………………………. 77
2.2.2 Risk Factors…………………………………. 78
2.2.3 Clinical Presentation…………………………. 78
2.2.4 Differential Diagnosis………………………… 78
2.2.5 Diagnosis……………………………………. 80
2.2.6 Treatment……………………………………. 83
2.2.7 Prognosis……………………………………. 86
2.3 Symptomatic Choledochal Cysts………………………… 86
2.3.1 Historical Perspective………………………… 86
2.3.2 Incidence……………………………………. 87
2.3.3 Pathophysiology………………………………. 87
2.3.4 Clinical Presentation…………………………. 87
2.3.5 Differential Diagnosis………………………… 87
2.3.6 Diagnosis……………………………………. 87
2.3.7 Treatment……………………………………. 88
2.3.8 Prognosis……………………………………. 90
References……………………………………………… 90
3 Acute Pancreatitis……………………………………… 101
3.1 Historical Perspective…………………………… 101
3.2 Incidence………………………………………… 102
3.2.1 Age, Trimester, and Race…………………….. 102
3.2.2 Hyperlipidemia/Dyslipidemia………………….. 103
3.2.3 Alcohol Abuse………………………………. 103
3.2.4 Primary Hyperparathyroidism………………….. 104
3.2.5 Preeclampsia/Eclampsia………………………. 104
3.2.6 Pancreatic Neoplasms………………………… 105
3.2.7 Acute Fatty Liver of Pregnancy……………….. 105
3.3 Etiopathogenesis………………………………….. 105
3.3.1 Introduction……………………………….. 105
3.3.2 Biliary……………………………………. 106
3.3.3 Primary Hyperparathyroidism………………….. 106
3.3.4 Acute Fatty Liver of Pregnancy……………….. 109
3.3.5 Hyperlipidemia/Dyslipidemia………………….. 110
3.3.6 Alcohol Abuse………………………………. 114
3.3.7 Medications………………………………… 115
3.3.8 Post-ERCP………………………………….. 115
3.3.9 Pancreatic Neoplasms………………………… 115
3.3.10 Preeclampsia/Eclampsia……………………… 116
3.3.11 Puerperium………………………………… 116
3.4 Clinical Presentation……………………………… 117
3.4.1 Medical History…………………………….. 117
3.4.2 Physical Examination………………………… 118
3.5 Diagnosis………………………………………… 119
3.5.1 Laboratory Findings…………………………. 119
3.5.2 Transabdominal Ultrasound……………………. 127
3.5.3 Abdominal CT……………………………….. 128
3.5.4 Endoscopic Ultrasound……………………….. 129
3.5.5 Abdominal MRI and MRCP………………………. 129
3.5.6 Endoscopic Retrograde Cholangiopancreatography . 129
3.5.7 Pancreatic Cyst Fluid Analysis……………….. 130
3.5.8 Imaging of the Parathyroid Glands…………….. 130
3.6 Differential Diagnosis…………………………….. 130
3.6.1 Acute Pancreatitis per se……………………. 130
3.6.2 Hypercalcemia………………………………. 131
3.7 Treatment………………………………………… 131
3.7.1 Conservative Treatment………………………. 131
3.7.2 Surgical Treatment………………………….. 140
3.7.3 Therapeutic Delivery………………………… 144
3.7.4 Obstetric Considerations…………………….. 145
3.8 Prognosis………………………………………… 146
3.8.1 General Considerations………………………. 146
3.8.2 Primary Hyperparathyroidism………………….. 148
3.8.3 Acute Fatty Liver of Pregnancy……………….. 149
3.8.4 Hypertriglyceridemia………………………… 149
3.8.5 Medications…………………………………. 150
3.8.6 Alcohol Abuse……………………………….. 150
References…………………………………………….. 150
4 Gastrointestinal Perforation…………………………….. 163
4.1 Perforated Peptic Ulcer…………………………….. 163
4.1.1 Peptic Ulcer in General………………………. 163
4.1.2 Perforated Peptic Ulcer in Pregnancy…………… 172
4.2 Perforated Malignant Peptic Ulcer/Carcinoma…………… 179
4.2.1 Gastric Cancer in Pregnancy…………………… 180
4.2.2 Perforated Gastric Cancer in Pregnancy…………. 183
4.3 Nonpeptic Ulcer Perforations/Ruptures………………… 183
4.3.1 Spontaneous Gastric Rupture…………………… 183
4.3.2 Postoperative Gastric Perforation/Rupture………. 185
4.4 Intestinal Perforation……………………………… 185
4.4.1 Intestinal Endometriosis……………………… 186
4.4.2 Colorectal Carcinoma…………………………. 188
4.4.3 Spontaneous Colorectal Perforation…………….. 193
4.4.4 Instrumental Abortion………………………… 194
References…………………………………………….. 196
5 Symptomatic Abdominal Wall Hernia………………………… 205
5.1 Groin Hernia………………………………………. 205
5.1.1 Incidence…………………………………… 206
5.1.2 Etiopathogenesis and Risk Factors……………… 206
5.1.3 Clinical Presentation………………………… 206
5.1.4 Differential Diagnosis……………………….. 207
5.1.5 Diagnosis…………………………………… 214
5.1.6 Treatment…………………………………… 214
5.1.7 Prognosis…………………………………… 217
5.2 Umbilical Hernia…………………………………… 217
5.2.1 Incidence…………………………………… 217
5.2.2 Etiopathogenesis…………………………….. 218
5.2.3 Clinical Presentation………………………… 219
5.2.4 Differential Diagnosis……………………….. 219
5.2.5 Diagnosis…………………………………… 223
5.2.6 Treatment…………………………………… 223
5.2.7 Prognosis…………………………………… 227
5.3 Epigastric Hernia………………………………….. 227
5.3.1 Incidence…………………………………… 227
5.3.2 Clinical Presentation………………………… 227
5.3.3 Differential Diagnosis……………………….. 227
5.3.4 Diagnosis…………………………………… 227
5.3.5 Treatment…………………………………… 227
5.3.6 Prognosis…………………………………… 227
5.4 Postoperative (Incisional) Hernia……………………. 227
5.4.1 Incidence…………………………………… 227
5.4.2 Clinical Presentation………………………… 229
5.4.3 Diagnosis…………………………………… 230
5.4.4 Treatment………………………………….. 232
5.4.5 Prognosis………………………………….. 235
5.5 Parastomal Hernia…………………………………. 237
5.5.1 Classification……………………………… 237
5.5.2 Incidence………………………………….. 238
5.5.3 Clinical Presentation……………………….. 238
5.5.4 Diagnosis………………………………….. 238
5.5.5 Treatment………………………………….. 239
5.6 Diastasis Recti Abdominis………………………….. 239
5.6.1 Anatomy……………………………………. 239
5.6.2 Incidence………………………………….. 240
5.6.3 Classification……………………………… 240
5.6.4 Treatment………………………………….. 240
References……………………………………………. 241
6 Symptomatic Diaphragmatic Hernia…………………………. 247
6.1 Historical Perspective…………………………….. 247
6.2 Etiology…………………………………………. 248
6.2.1 Acute Diaphragmatic Fatigue………………….. 248
6.2.2 Diaphragmatic Eventration……………………. 248
6.2.3 Diaphragmatic Hernia………………………… 248
6.3 Clinical Presentation……………………………… 251
6.3.1 Hiatal…………………………………….. 251
6.3.2 Posttraumatic………………………………. 252
6.3.3 Congenital…………………………………. 254
6.4 Differential Diagnosis…………………………….. 254
6.5 Diagnosis………………………………………… 255
6.5.1 Chest Radiography…………………………… 255
6.5.2 Thoracic Ultrasound…………………………. 256
6.5.3 Thoracic CT………………………………… 257
6.5.4 Thoracic MRI……………………………….. 258
6.6 Treatment………………………………………… 258
6.6.1 Conservative Treatment………………………. 259
6.6.2 Surgical Treatment………………………….. 259
6.7 Prognosis………………………………………… 264
6.7.1 Maternal Outcome……………………………. 264
6.7.2 Fetal Outcome………………………………. 264
References……………………………………………. 264
7 Intestinal Obstruction………………………………….. 269
7.1 General Considerations…………………………….. 269
7.1.1 Historical Perspective………………………. 269
7.1.2 Incidence………………………………….. 270
7.1.3 Clinical Presentation……………………….. 271
7.1.4 Differential Diagnosis………………………. 271
7.1.5 Treatment………………………………….. 275
7.1.6 Prognosis………………………………….. 276
7.2 Intussusception…………………………………… 277
7.2.1 General Considerations………………………. 277
7.2.2 Historical Perspective………………………. 277
7.2.3 Incidence…………………………………. 278
7.2.4 Etiopathogenesis…………………………… 278
7.2.5 Clinical Presentation………………………. 279
7.2.6 Differential Diagnosis……………………… 280
7.2.7 Diagnosis…………………………………. 280
7.2.8 Treatment…………………………………. 283
7.2.9 Prognosis…………………………………. 284
7.3 Transvaginal Instrumental Uterine Perforation………… 284
7.3.1 Introduction………………………………. 284
7.3.2 Incidence…………………………………. 284
7.3.3 Risk Factors………………………………. 285
7.3.4 Mechanisms of Small Bowel Obstruction………… 285
7.3.5 Clinical Presentation………………………. 287
7.3.6 Diagnosis…………………………………. 288
7.3.7 Treatment…………………………………. 290
7.3.8 Prognosis…………………………………. 291
7.4 Adhesions………………………………………… 292
7.4.1 Definition and Classification……………….. 292
7.4.2 Incidence…………………………………. 292
7.4.3 Pathophysiology……………………………. 292
7.4.4 Prevention………………………………… 294
7.4.5 Diagnosis…………………………………. 295
7.4.6 Treatment…………………………………. 295
7.5 Small Bowel Volvulus………………………………. 296
7.5.1 Small Bowel Volvulus……………………….. 296
7.5.2 Congenital Intestinal Malrotation……………. 298
7.5.3 Ileosigmoid Knotting……………………….. 299
7.6 Carcinoma of the Colon and Rectum…………………… 302
7.6.1 Historical Perspective……………………… 302
7.6.2 Incidence…………………………………. 302
7.6.3 Carcinogenesis and Risk Factors……………… 303
7.6.4 Clinical Presentation………………………. 304
7.6.5 Differential Diagnosis……………………… 304
7.6.6 Diagnosis…………………………………. 305
7.6.7 Treatment…………………………………. 306
7.6.8 Prognosis…………………………………. 308
7.7 Intestinal Stomal Obstruction………………………. 310
7.7.1 Intussusception and Prolapse………………… 310
7.7.2 Extraluminal Stomal Compression……………… 311
7.8 Sigmoid Volvulus………………………………….. 313
7.8.1 Incidence…………………………………. 313
7.8.2 Pathophysiology and Risk Factors…………….. 313
7.8.3 Clinical Presentation………………………. 314
7.8.4 Diagnosis…………………………………. 315
7.8.5 Treatment…………………………………. 315
7.8.6 Prognosis…………………………………. 318
7.9 Cecal Volvulus……………………………………. 318
7.9.1 General Considerations……………………… 318
7.9.2 Historical Perspective………………………. 318
7.9.3 Incidence and Risk Factors…………………… 318
7.9.4 Clinical Presentation……………………….. 319
7.9.5 Differential Diagnosis………………………. 319
7.9.6 Diagnosis………………………………….. 319
7.9.7 Treatment………………………………….. 320
7.9.8 Prognosis………………………………….. 321
7.10 Incarcerated Internal Hernia……………………….. 321
7.10.1 Post-Bariatric Surgery………………………. 321
7.10.2 Congenital Defects…………………………. 325
7.11 Gastric Outlet Obstruction…………………………. 327
7.11.1 Heterotopic Pancreas………………………… 327
7.12 Gynecologic Causes………………………………… 328
7.12.1 Ovarian Teratoma……………………………. 328
7.12.2 Ectopic Pregnancy………………………….. 329
7.12.3 Normal Pregnancy…………………………… 330
References…………………………………………….. 333
8 Acute Inflammatory Bowel Disease…………………………. 345
8.1 Crohn’s Disease……………………………………. 345
8.1.1 Introduction……………………………….. 345
8.1.2 Effect of Pregnancy…………………………. 345
8.1.3 Pathophysiology…………………………….. 347
8.1.4 Clinical Presentation……………………….. 348
8.1.5 Diagnosis………………………………….. 348
8.1.6 Differential Diagnosis………………………. 350
8.1.7 Treatment………………………………….. 350
8.1.8 Prognosis………………………………….. 360
8.2 Ulcerative Colitis…………………………………. 364
8.2.1 Incidence………………………………….. 364
8.2.2 Effect of Pregnancy…………………………. 364
8.2.3 Classification……………………………… 366
8.2.4 Pathophysiology…………………………….. 366
8.2.5 Clinical Presentation……………………….. 366
8.2.6 Differential Diagnosis………………………. 367
8.2.7 Diagnosis………………………………….. 367
8.2.8 Treatment………………………………….. 370
8.2.9 Prognosis………………………………….. 373
References…………………………………………….. 377
9 Spleen………………………………………………… 385
9.1 Splenic Rupture……………………………………. 385
9.1.1 Definition and Historical Perspective…………. 385
9.1.2 Classification……………………………… 386
9.1.3 Clinical Presentation……………………….. 389
9.1.4 Differential Diagnosis………………………. 390
9.1.5 Diagnosis………………………………….. 391
9.1.6 Treatment………………………………….. 392
9.1.7 Prognosis………………………………….. 393
9.2 Ruptured Splenic Pregnancy………………………….. 394
9.2.1 Definition and Classification………………… 394
9.2.2 Incidence………………………………….. 394
9.2.3 Pathophysiology…………………………….. 394
9.2.4 Risk Factors……………………………….. 395
9.2.5 Clinical Presentation……………………….. 395
9.2.6 Diagnosis………………………………….. 395
9.2.7 Treatment………………………………….. 396
9.3 Spontaneous Splenic Artery (Aneurysm) Rupture…………. 396
9.3.1 Historical Perspective………………………. 396
9.3.2 Incidence………………………………….. 396
9.3.3 Risk Factors……………………………….. 398
9.3.4 Pathophysiology…………………………….. 398
9.3.5 Clinical Presentation……………………….. 399
9.3.6 Differential Diagnosis………………………. 399
9.3.7 Diagnosis………………………………….. 399
9.3.8 Treatment………………………………….. 401
9.3.9 Prognosis………………………………….. 401
9.4 Spontaneous Splenic Vein (Aneurysm) Rupture…………… 402
9.4.1 Historical Perspective and Incidence………….. 402
9.4.2 Etiology…………………………………… 402
9.4.3 Risk Factors……………………………….. 403
9.4.4 Pathophysiology…………………………….. 403
9.4.5 Clinical Presentation……………………….. 404
9.4.6 Differential Diagnosis………………………. 404
9.4.7 Diagnosis………………………………….. 404
9.4.8 Treatment………………………………….. 404
9.4.9 Prognosis………………………………….. 405
9.5 Splenic Torsion……………………………………. 405
9.5.1 Historical Perspective and Incidence………….. 405
9.5.2 Etiopathogenesis……………………………. 405
9.5.3 Clinical Presentation……………………….. 405
9.5.4 Differential Diagnosis………………………. 406
9.5.5 Diagnosis………………………………….. 406
9.5.6 Treatment………………………………….. 406
9.5.7 Prognosis………………………………….. 407
References…………………………………………….. 407
10 Abdominal Trauma……………………………………….. 413
10.1 General Considerations…………………………….. 413
10.1.1 Incidence………………………………….. 413
10.1.2 Risk Factors……………………………….. 414
10.1.3 Prevention…………………………………. 416
10.1.4 Anatomic and Physiologic Changes Relevant
to Trauma………………………………….. 416
10.1.5 The Impact of Pregnancy on Trauma Mortality. . . . 420
10.1.6 Major Hemorrhage……………………………. 420
10.1.7 Prehospital Issues………………………….. 422
10.2 Anesthetic Management…………………………….. 424
10.3 Blunt Trauma…………………………………….. 425
10.3.1 Incidence……………………………….. 425
10.3.2 Motor Vehicle Accidents…………………… 425
10.3.3 Falls…………………………………… 442
10.3.4 Social/Domestic Violence………………….. 442
10.3.5 Obstetric Complications…………………… 444
10.3.6 Diagnosis……………………………….. 456
10.3.7 Treatment……………………………….. 462
10.3.8 Prognosis……………………………….. 469
10.4 Penetrating Trauma………………………………. 473
10.4.1 Incidence and Type……………………….. 473
10.4.2 Clinical Presentation…………………….. 474
10.4.3 Diagnosis……………………………….. 474
10.4.4 Treatment……………………………….. 479
10.4.5 Prognosis……………………………….. 491
References…………………………………………… 492
11 Miscellaneous Conditions………………………………. 505
11.1 Spontaneous Liver Rupture………………………… 505
11.1.1 Historical Perspective……………………. 505
11.1.2 Incidence……………………………….. 506
11.1.3 Etiopathogenesis…………………………. 507
11.1.4 Clinical Presentation…………………….. 508
11.1.5 Differential Diagnosis……………………. 508
11.1.6 Diagnosis……………………………….. 508
11.1.7 Treatment……………………………….. 509
11.1.8 Prognosis……………………………….. 513
11.2 Peptic Ulcer Bleeding…………………………….. 513
11.2.1 Introduction…………………………….. 513
11.2.2 Incidence……………………………….. 514
11.2.3 Risk Factors…………………………….. 515
11.2.4 Diagnosis……………………………….. 515
11.2.5 Treatment……………………………….. 515
11.2.6 Prognosis……………………………….. 515
11.3 Mesenteric Ischemia………………………………. 516
11.3.1 Mesenteric Vein Thrombosis………………… 516
11.3.2 Portal Vein Thrombosis……………………. 520
11.4 Inferior Epigastric Artery Bleeding……………….. 521
11.4.1 Anatomy…………………………………. 521
11.4.2 Historical Perspective……………………. 522
11.4.3 Incidence……………………………….. 522
11.4.4 Mechanism of Injury………………………. 522
11.4.5 Clinical Presentation…………………….. 523
11.4.6 Differential Diagnosis……………………. 525
11.4.7 Diagnosis……………………………….. 525
11.4.8 Treatment……………………………….. 526
11.4.9 Prognosis……………………………….. 526
11.5 Omental Infarction………………………………… 527
11.5.1 Incidence………………………………….. 527
11.5.2 Etiology…………………………………… 527
11.5.3 Clinical Presentation……………………….. 528
11.5.4 Differential Diagnosis………………………. 528
11.5.5 Diagnosis………………………………….. 528
11.5.6 Treatment………………………………….. 529
11.5.7 Prognosis………………………………….. 529
11.6 Gastrointestinal-Genital Communications……………… 529
11.6.1 Introduction……………………………….. 529
11.6.2 Incidence………………………………….. 529
11.6.3 Etiopathogenesis……………………………. 530
11.6.4 Prevention…………………………………. 532
11.6.5 Clinical Presentation……………………….. 532
11.6.6 Diagnosis………………………………….. 532
11.6.7 Treatment………………………………….. 533
11.6.8 Prognosis………………………………….. 533
References…………………………………………….. 534
Part II Gynecology
12 Adnexal Torsion………………………………………… 543
12.1 Introduction……………………………………… 543
12.2 Historical Perspective…………………………….. 544
12.3 Incidence………………………………………… 544
12.4 Risk Factors……………………………………… 545
12.4.1 Adnexal Mass……………………………….. 545
12.4.2 Anatomic Variations of Adnexa………………… 545
12.4.3 Assisted Reproductive Technologies……………. 545
12.4.4 Pregnancy and Trimester……………………… 546
12.5 Clinical Presentation……………………………… 546
12.5.1 Medical History…………………………….. 546
12.5.2 Physical Examination………………………… 546
12.6 Differential Diagnosis…………………………….. 547
12.7 Diagnosis………………………………………… 547
12.7.1 Laboratory Findings…………………………. 547
12.7.2 Transvaginal Ultrasound……………………… 548
12.7.3 Abdominal CT……………………………….. 550
12.7.4 Abdominal MRI………………………………. 550
12.8 Treatment………………………………………… 550
12.8.1 Operative Principles………………………… 551
12.8.2 Operative Techniques………………………… 553
12.8.3 Adnexal Pathology…………………………… 557
12.8.4 Anesthetic and Perioperative Management……….. 557
12.8.5 Obstetric Management………………………… 557
12.9 Prognosis………………………………………… 558
12.9.1 Duration of Symptoms………………………… 558
12.9.2 Risk of Recurrence………………………….. 558
References…………………………………………….. 558
13 Isolated Fallopian Tube Torsion……………………….. 563
13.1 Historical Perspective……………………………. 563
13.2 Incidence……………………………………….. 563
13.3 Risk Factors and Pathophysiology…………………… 564
13.3.1 Risk Factors………………………………. 564
13.3.2 Pathophysiology……………………………. 564
13.4 Clinical Presentation…………………………….. 565
13.5 Differential Diagnosis……………………………. 565
13.6 Diagnosis……………………………………….. 565
13.6.1 Laboratory Findings………………………. 565
13.6.2 Abdominal Ultrasound…………………….. 566
13.6.3 Abdominal CT……………………………. 566
13.6.4 Abdominal MRI…………………………… 566
13.7 Treatment……………………………………….. 568
13.7.1 Abdominal Entry……………………………. 568
13.7.2 Surgical Procedures………………………… 569
13.7.3 Anesthetic and Perioperative Management………. 570
13.7.4 Prevention and Treatment of Preterm Labor…… 570
13.8 Prognosis……………………………………….. 570
References……………………………………………. 571
14 Complex Ovarian Mass…………………………………… 573
14.1 Incidence and Classification………………………. 573
14.1.1 Ovarian Cysts……………………………… 574
14.1.2 Ovarian Teratoma…………………………… 575
14.1.3 Other Ovarian Tumors……………………….. 575
14.1.4 Ovarian Endometrioma……………………….. 575
14.2 Clinical Presentation…………………………….. 576
14.3 Differential Diagnosis……………………………. 576
14.4 Diagnosis……………………………………….. 577
14.4.1 Laboratory Findings………………………… 577
14.4.2 Abdominal Ultrasound……………………….. 577
14.4.3 Abdominal MRI……………………………… 578
14.5 Treatment……………………………………….. 579
14.5.1 Introduction………………………………. 579
14.5.2 Conservative Treatment……………………… 579
14.5.3 Surgical Treatment…………………………. 580
14.5.4 Anesthetic and Perioperative Management………. 583
14.6 Prognosis……………………………………….. 584
14.6.1 Maternal Outcome…………………………… 584
14.6.2 Fetal Outcome……………………………… 584
References……………………………………………. 584
15 Ruptured Ectopic Pregnancy……………………………… 589
15.1 Ectopic Pregnancy in General………………………. 589
15.1.1 Incidence…………………………………. 589
15.1.2 Risk Factors………………………………. 590
15.1.3 Classification…………………………….. 590
15.1.4 Clinical Presentation………………………. 591
15.1.5 Differential Diagnosis……………………… 594
15.1.6 Diagnosis…………………………………. 595
15.1.7 Treatment…………………………………. 599
15.1.8 Prognosis…………………………………. 602
15.2 Ruptured Cornual Pregnancy………………………… 602
15.2.1 Definition………………………………… 602
15.2.2 Incidence and Pathophysiology……………….. 602
15.2.3 Clinical Presentation………………………. 603
15.2.4 Diagnosis…………………………………. 604
15.2.5 Treatment…………………………………. 605
15.2.6 Prognosis…………………………………. 608
15.3 Abdominal Pregnancy………………………………. 608
15.3.1 Historical Perspective……………………… 608
15.3.2 Classification…………………………….. 608
15.3.3 Incidence…………………………………. 608
15.3.4 Risk Factors………………………………. 609
15.3.5 Clinical Presentation………………………. 609
15.3.6 Diagnosis…………………………………. 610
15.3.7 Treatment…………………………………. 611
15.3.8 Prognosis…………………………………. 615
References……………………………………………. 615
16 Spontaneous Uterine Rupture…………………………… 621
16.1 Historical Perspective……………………………. 621
16.2 Classification and Mechanisms……………………… 622
16.2.1 Definition………………………………… 622
16.2.2 Classification…………………………….. 623
16.2.3 Mechanisms of Uterine Rupture……………….. 624
16.3 Incidence……………………………………….. 626
16.3.1 Developed/Undeveloped Country……………….. 626
16.3.2 Decade Dependency………………………….. 626
16.4 Risk Factors…………………………………….. 627
16.4.1 Scarred Uterus…………………………….. 627
16.4.2 Unscarred Uterus…………………………… 633
16.4.3 Operative Procedure………………………… 637
16.5 Prevention of Uterine Rupture……………………… 639
16.5.1 Scarred Uterus…………………………….. 639
16.6 Clinical Presentation…………………………….. 640
16.6.1 Symptoms and Signs…………………………. 640
16.6.2 Physical Examination……………………….. 642
16.7 Diagnosis……………………………………….. 642
16.7.1 Laboratory Findings………………………… 642
16.7.2 Abdominal Ultrasound……………………….. 643
16.7.3 Abdominal CT………………………………. 643
16.7.4 Abdominal MRI……………………………… 644
16.7.5 Uterine Tone Monitoring…………………….. 645
16.8 Treatment……………………………………….. 647
16.8.1 Perioperative Management…………………… 647
16.8.2 Operative Treatment……………………….. 647
16.9 Prognosis………………………………………. 652
16.9.1 Maternal Outcome………………………….. 652
16.9.2 Fetal Outcome…………………………….. 653
References…………………………………………… 654
17 Torsion of the Gravid Uterus……………………………. 663
17.1 Historical Perspective…………………………… 663
17.2 Incidence………………………………………. 663
17.3 Etiopathogenesis………………………………… 664
17.3.1 General Population………………………… 664
17.3.2 Pregnancy………………………………… 665
17.3.3 Puerperium……………………………….. 666
17.4 Clinical Presentation……………………………. 666
17.4.1 Pregnancy………………………………… 666
17.4.2 Puerperium……………………………….. 667
17.5 Differential Diagnosis…………………………… 668
17.6 Diagnosis………………………………………. 668
17.6.1 Plain Abdominal X-Ray……………………… 668
17.6.2 Abdominal Ultrasound………………………. 668
17.6.3 Abdominal CT……………………………… 668
17.6.4 Abdominal MRI…………………………….. 668
17.7 Treatment………………………………………. 668
17.7.1 Operative Treatment……………………….. 669
17.7.2 Obstetric Management………………………. 671
17.7.3 Anesthetic and Perioperative Management…….. 671
17.8 Prognosis……………………………………… 671
17.8.1 Maternal Outcome…………………………. 671
17.8.2 Fetal Outcome…………………………….. 672
References…………………………………………… 672
18 Symptomatic Uterine Myoma………………………………. 675
18.1 Definition and Classification…………………….. 675
18.1.1 General Population………………………… 675
18.1.2 Classification……………………………. 675
18.2 Incidence………………………………………. 676
18.2.1 Red Degeneration………………………….. 676
18.2.2 Spontaneous Bleeding………………………. 677
18.2.3 Torsion of the Gravid Uterus……………….. 677
18.3 Clinical Presentation……………………………. 677
18.3.1 Medical History…………………………… 677
18.3.2 Physical Examination………………………. 677
18.4 Differential Diagnosis…………………………… 678
18.5 Diagnosis………………………………………. 678
18.5.1 Abdominal Ultrasound………………………. 678
18.5.2 Abdominal MRI…………………………….. 679
18.6 Treatment………………………………………. 679
18.6.1 Historical Perspective…………………….. 679
18.6.2 Emergent Presentation……………………… 680
18.6.3 Elective Presentation……………………… 681
18.6.4 Perioperative Management…………………… 682
18.7 Prognosis……………………………………….. 682
18.7.1 Maternal Outcome………………………….. 682
18.7.2 Neonatal Outcome………………………….. 682
References……………………………………………. 683
19 Complicated Pelvic Inflammatory Disease………………….. 685
19.1 General Female Population……………………….. 685
19.1.1 Tubo-Ovarian Abscess………………………. 685
19.1.2 Ovarian Abscess…………………………… 689
19.2 Incidence……………………………………….. 689
19.2.1 Acute Salpingitis…………………………. 689
19.2.2 Tubo-Ovarian Abscess………………………. 689
19.2.3 Ovarian Abscess…………………………… 689
19.2.4 Intramyometrial and Uterine Horn Abscess…… 690
19.3 Etiopathogenesis…………………………………. 690
19.3.1 Suppurative Salpingitis……………………. 690
19.3.2 Tubo-Ovarian Abscess………………………. 692
19.3.3 Ovarian Abscess…………………………… 695
19.3.4 Intramyometrial Abscess……………………. 695
19.4 Microbiology…………………………………….. 696
19.5 Clinical Presentation……………………………. 696
19.5.1 Suppurative Salpingitis……………………. 696
19.5.2 Tubo-Ovarian Abscess………………………. 697
19.5.3 Ovarian Abscess…………………………… 698
19.6 Differential Diagnosis……………………………. 698
19.7 Diagnosis……………………………………….. 698
19.7.1 Laboratory Findings……………………….. 698
19.7.2 Abdominal Ultrasound………………………. 698
19.7.3 Abdominal CT……………………………… 699
19.7.4 Abdominal MRI…………………………….. 699
19.7.5 Bacterial Cultures………………………… 700
19.8 Prevention of Infection…………………………… 700
19.8.1 Preprocedural Elimination of Endometriosis …. 700
19.8.2 Procedural Vaginal Antisepsis………………. 700
19.8.3 Prophylactic Antibiotics/Antifungal Agents…. 701
19.9 Treatment……………………………………….. 701
19.9.1 Medical Treatment…………………………. 701
19.9.2 Surgical Treatment………………………… 701
19.9.3 Anesthetic and Perioperative Management……. 702
19.9.4 Obstetric Management………………………. 702
19.10 Prognosis………………………………………. 703
19.10.1 Maternal Outcome…………………………. 703
19.10.2 Fetal Outcome……………………………. 703
References……………………………………………. 704
Part III Additional Considerations
20 Urologic Emergencies……………………………………. 711
20.1 Anatomic and Functional Changes of the Urinary
Tract During Pregnancy…………………………….. 711
20.1.1 Upper Urinary Tract……………………….. 711
20.1.2 Lower Urinary Tract……………………….. 711
20.1.3 Composition of the Urine……………………. 712
20.2 Symptomatic Urinary Tract Stones………………….. 712
20.2.1 Incidence…………………………………. 712
20.2.2 Etiopathogenesis…………………………… 712
20.2.3 Clinical Presentation………………………. 713
20.2.4 Differential Diagnosis……………………… 713
20.2.5 Diagnosis…………………………………. 714
20.2.6 Treatment…………………………………. 715
20.2.7 Prognosis…………………………………. 717
20.3 Acute Pyelonephritis……………………………… 717
20.3.1 Incidence…………………………………. 717
20.3.2 Etiopathogenesis…………………………… 717
20.3.3 Clinical Presentation………………………. 718
20.3.4 Differential Diagnosis……………………… 718
20.3.5 Diagnosis…………………………………. 718
20.3.6 Treatment…………………………………. 718
20.3.7 Prognosis…………………………………. 719
20.4 Acute Urinary Retention…………………………… 719
20.4.1 Incidence…………………………………. 719
20.4.2 Etiopathogenesis…………………………… 720
20.4.3 Clinical Presentation………………………. 721
20.4.4 Differential Diagnosis……………………… 721
20.4.5 Diagnosis…………………………………. 722
20.4.6 Treatment…………………………………. 723
20.4.7 Prognosis…………………………………. 724
20.5 Renal Collecting System or Parenchymal Rupture……… 724
20.5.1 Incidence and Etiopathogenesis………………. 724
20.5.2 Clinical Presentation………………………. 726
20.5.3 Differential Diagnosis……………………… 727
20.5.4 Diagnosis…………………………………. 727
20.5.5 Treatment…………………………………. 729
20.5.6 Prognosis…………………………………. 732
20.6 Urinary Bladder Injury/Rupture…………………….. 732
20.6.1 Incidence…………………………………. 732
20.6.2 Etiopathogenesis…………………………… 733
20.6.3 Clinical Presentation………………………. 734
20.6.4 Differential Diagnosis……………………… 735
20.6.5 Diagnosis…………………………………. 735
20.6.6 Treatment…………………………………. 736
20.6.7 Prognosis…………………………………. 738
20.7 Renal Artery Aneurysm Rupture……………………… 738
20.7.1 Incidence………………………………… 738
20.7.2 Etiopathogenesis………………………….. 738
20.7.3 Clinical Presentation……………………… 739
20.7.4 Differential Diagnosis…………………….. 739
20.7.5 Diagnosis………………………………… 739
20.7.6 Treatment………………………………… 740
20.7.7 Prognosis………………………………… 742
References…………………………………………… 744
21 Anesthetic and Perioperative Management…………………. 751
21.1 Anesthetic Management……………………………. 751
21.1.1 Anesthetic Medications…………………….. 751
21.1.2 Airway Management…………………………. 752
21.1.3 Intraoperative C02 Monitoring………………. 756
21.1.4 Extracorporeal Membranous Oxygenation……….. 756
21.2 Medications…………………………………….. 757
21.2.1 Antibiotics………………………………. 757
21.2.2 Pain Management…………………………… 758
21.2.3 Thromboprophylaxis………………………… 759
21.3 Perioperative Management…………………………. 763
21.3.1 Fetal Heart Rate Monitoring………………… 763
21.3.2 Nutrition and Dietary Supplements…………… 765
References…………………………………………… 765
22 Increased Intra-Abdominal Pressure……………………… 769
22.1 Intra-Abdominal Hypertension……………………… 769
22.1.1 Introduction……………………………… 769
22.1.2 The Physiology of Normal Pregnancy………….. 770
22.1.3 Intra-Abdominal Pressure in Normal Pregnancy. . . 771
22.1.4 Pathophysiology of ІАНУ ACS………………… 772
22.2 Etiopathogenesis………………………………… 774
22.2.1 Nonoperative Conditions……………………. 774
22.2.2 Operative Conditions………………………. 776
22.3 Clinical Presentation……………………………. 780
22.4 Diagnosis………………………………………. 780
22.4.1 Intra-Abdominal Pressure Measurement………… 780
22.4.2 Laboratory Findings……………………….. 780
22.4.3 Plain Chest X-Ray…………………………. 780
22.4.4 Abdominal Ultrasound………………………. 780
22.5 Treatment………………………………………. 781
22.5.1 Nonoperative Treatment…………………….. 781
22.5.2 Operative Treatment……………………….. 781
22.5.3 Therapeutic Delivery………………………. 783
22.6 Prognosis………………………………………. 784
22.6.1 Maternal Outcome………………………….. 784
22.6.2 Fetal Outcome…………………………….. 784
References…………………………………………… 784
23 Acute Abdomen-Induced Preterm Labor……………………. 789
23.1 Definitions……………………………………… 789
23.2 Physiology of Labor………………………………. 789
23.2.1 Myometrial Contractility…………………… 790
23.2.2 Cervical Remodeling……………………….. 791
23.2.3 Decidual/Membrane Activation……………….. 791
23.2.4 Prostaglandins and Parturition……………… 791
23.3 Etiopathogenesis…………………………………. 792
23.3.1 Inflammation……………………………… 792
23.3.2 Maternal and Fetal Stress………………… 795
23.3.3 Placental Abruption……………………… 798
23.3.4 Maternal Nutritional Status………………… 799
23.3.5 Final Common Pathway………………………. 800
23.4 Clinical Presentation……………………………. 800
23.5 Diagnosis………………………………………. 801
23.5.1 Prediction of Preterm Labor………………. 801
23.5.2 Preterm Premature Rupture of Membranes…….. 801
23.5.3 Placental Pathology……………………….. 801
23.6 Treatment………………………………………. 802
23.6.1 Nontocolytic Treatment…………………….. 803
23.6.2 Tocolytics……………………………….. 804
23.6.3 Combination Treatment……………………… 809
23.7 Prognosis………………………………………. 809
23.7.1 Fetal Inflammatory Response Syndrome………… 809
23.7.2 Fetal Mortality…………………………… 810
23.7.3 Fetal Morbidity…………………………… 810

© Электронная библиотека по истории акушерства и гинекологии
2018