The Pregnant Peritonitis
- The gravid uterus can mask the signs of peritoneal irritation (guarding, rigidity and rebound tenderness) by preventing the inflamed organ from contacting the peritoneum.
- Due to increased white blood cells that naturally occur during pregnancy, leukocytosis is not helpful in identifying acute pathology.
- A relative increase in blood volume can delay the development of tachycardia and hypotension in the truly ill patient.
- Consider appendicitis in the patient complaining of typical signs and symptoms of appendicitis even if confounded by right middle and upper quadrant abdominal pain, pyuria, urinary symptoms and subtle signs of peritonitis.
- HELLP syndrome is managed with blood pressure control, prevention of seizures, correction of coagulopathy, and delivery of the fetus.
- Radiological investigations, including abdominal plain films, can be safely undertaken during pregnancy and should always be considered so as to avoid delays and failures in diagnosing potentially life-threatening conditions.
The abdominal x-rays show dilated small bowel loops with air fluid levels. The erect abdominal x-ray, on close examination shows air in the biliary tree. There are multiple rounded irregular densities in the mid abdomen (turned out to be calcified mesenteric lymph nodes on CT). This patient likely has a small bowel obstruction secondary to gall stone.