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JAMA Surgery Clinical Challenge
October 31, 2018

Abdominal Pain in Pregnancy

Author Affiliations
  • 1General Surgery B, Soroka University Medical Center, Be’er Sheva, Israel
JAMA Surg. 2019;154(2):176-177. doi:10.1001/jamasurg.2018.3860

A healthy 29-year-old pregnant woman, with 34 weeks’ gestational age, presented to the emergency department with diffused acute abdominal pain and vomiting. The pain was located in the periumbilical region and intensified within a few hours. The patient felt normal fetal movements during this time. An initial surgical evaluation was done, and the cause for the abdominal pain was assumed to be not of surgical condition. Next, the patient was evaluated by an obstetrician-gynecologist, and although the gynecologic examination, ultrasonography, and monitoring were all normal, the patient was admitted for further supervision in the obstetrics department. The next day, when the abdominal pain and vomiting persisted and an elevated leukocyte blood count of 14 200/mL was noted (to convert to ×109 per liter, multiply by 0.001), a second surgical consultation was done. The physical examination was significant for diffuse abdominal tenderness. Although the patient was pregnant, and owing to nonavailability of magnetic resonance imaging at that time, a contrast-enhanced abdominopelvic computed tomography was performed (Figure 1).

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