妊娠中の急性腹症に対して腹腔鏡下手術が有用であった症例

抄録

  The etiology of acute abdominal pain during pregnancy is multifactorial including pregnancy condition, obstetrical complications, gastrointestinal and/or genitourinary conditions, and several other causes. Delayed diagnosis and treatment can increase the risk of maternal and fetal morbidity and mortality; therefore, prompt evaluation is warranted.

Case: The patient presented with a right ovarian cyst at the 9^th week of gestation. She was admitted to our hospital with sudden onset of abdominal pain at the gestational age of 19 weeks. Physical examination showed right-sided abdominal tenderness. Ultrasonography revealed that the area of tenderness corresponded to the area over the right ovarian cyst. Therefore, we suspected ovarian tumor torsion or appendicitis. Two-port laparoscopic right ovarian cystectomy was performed; however, ovarian torsion was not identified, and appendicitis was suspected. Simultaneous laparoscopic appendectomy was performed using the same port positions. Diagnosis of appendicitis during pregnancy is challenging. In addition to ovarian torsion, appendicitis and other conditions should be suspected in pregnant women with right-sided abdominal pain with concomitant right-sided ovarian cysts. Laparoscopy is useful to diagnose acute abdomen, and diagnostic laparoscopy is warranted even in pregnant women, if clinically indicated.