An unusual presentation of acute abdomen in early pregnancy: a case report

Abstract

Acute abdomen is characterized by pain, tenderness and muscular rigidity, and for which emergency surgery must be considered. Acute abdomen in pregnancy can be obstetric or non-obstetric. Differential diagnoses include acute appendicitis, gastroenteritis, bowel obstruction and perforated peptic ulcers, ectopic pregnancy, peduncular torsion of an ovarian cyst, ovarian bleeding, pelvic inflammatory disease, mesenteric venous thrombosis, rupture of visceral artery aneurysm and foreign bodies.

The case report presented is of a 23-year-old, para 2+1, gravida 4 at 16 weeks’ gestation who presented to the Accident and Emergency Department of Kenyatta National Hospital with a four-day history of abdominal pain, constipation and vomiting. General examination revealed a sick looking, dehydrated, pale lady with a tachycardia of 108 beats per minute and blood pressure of 107/70mm/Hg. Abdominal examination revealed gaseous distension, generalized tenderness, rebound tenderness and absent bowel sounds. The external cervical os was closed and had candidal discharge. A kidney, ureter and bladder ultrasound reported free fluid in the hepatorenal space. An exploratory laparotomy found a 15-20cm long transparent plastic tube invaginating through the anterior pylorus/first part of duodenum with a small purulent pocket around it. An omental patch and peritoneal lavage were done and a drain left in-situ. The patient did well post-operatively and was discharged on day 12 post-op. This case is presented to raise awareness of less common causes of acute abdomen and highlight the risks of clandestine abortion attempts.