妊娠を契機に出現した原因不明の急性腹症（下腹部痛）に対して審査腹腔鏡を行い、癒着剥離術により症状が消失した１症例

抄録

Objective: Diagnosing lower abdominal pain in early pregnancy is often difficult due to the dangers of radiation exposure associated with diagnostic imaging. Here we report a case in which lower abdominal pain of unknown etiology in the first trimester of pregnancy was relieved by laparoscopy after removal of adhesions around the uterus and uterine adnexa.

Case: A 28-year-old woman underwent laparoscopic enucleation of a left ovarian tumor at age 25. She presented to our department with labor-like lower abdominal pain at 6 weeks and 2 days after her last menstrual period. Since there were no abnormal findings, she was followed up by observation. However, the pain gradually increased and she was admitted to our department for pain management and to investigate the cause. Blood tests showed elevated β-human chorionic gonadotrophin levels, but there was no fetal sac in the uterus; thus, miscarriage and ectopic pregnancy were considered. At 7 weeks and 2 days after the last menstrual period, a fetal sac was found in the uterus. On the same day, we performed laparoscopy to determine the cause of the abdominal pain. Adhesions around the uterine adnexa were found and removed. The patient’s lower abdominal pain disappeared postoperatively.

Conclusion: Laparoscopy may be an option for diagnosing patients in early pregnancy who have lower abdominal pain of unknown etiology.