ACUTE APPENDICITIS DURING PREGNANCY: NO PLACE FOR MAYBE

G. Radu1, Nicoleta Prună1, S. Prună1, Mirela Moarcăș1, Adriana Andrei1, Dina Mohammad1, O. Munteanu1,2, Monica Mihaela Cîrstoiu1,2

1The Obstetrics and Gynecology Department, Bucharest Emergency University Hospital
2The University of Medicine and Pharmacy “Carol Davila” Bucharest, Romania

Corresponding author: Gabriel Radu 
Phone no. 0040213180519
Email: This email address is being protected from spambots. You need JavaScript enabled to view it.

Abstract

Before the use of ultrasound, many ovarian tumors remained undiagnosed until cesarean section or until they became symptomatic. Now, many symptomatic or non-symptomatic adnexal tumors are diagnosed by ultrasound during pregnancy follow-up.In most cases, the adnexal tumors discovered during pregnancy are benign with a maximum diameter of 5 cm. Approximately 70% of the cystic adnexal tumors identified in the first trimester resorb spontaneously until the beginning of the second trimester (usually those are functional cysts). Persistent adnexal tumors larger than 5 cm are generally mature teratomas (dermoid).In this case, at the emergency room a 34 year-old- women came with almost 20 weeks pregnancy, accusing acute abdominal pain, nausea and vomiting. One week before, the patient went for a routine ultrasound for pregnancy and the doctor discovered a giant tumor larger than 15 cm (due to the size it could not be measured) with fluid content. Two days before the symptoms, the patient went for an abdominal MRI where a voluminous pelvic-abdominal cyst with almost 30 cm in diameter was discovered. Differential diagnosis: ovarian torsion or ruptured cyst complicating pregnancy. What is the correct diagnosis and what is to be done since there is a 20 weeks pregnancy?

Keywordsgiant cyst, ovarian tumor, pregnancy, MRI, acute abdominal pain

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Monday the 23rd.