ANC with acute abdomen: a case report from secondary care hospital, Western Maharashtra

Female body undergoes numerous anatomical and physiological changes in pregnancy which make diagnosis and management of acute abdomen in pregnancy as a most challenging situation. This may lead to dilemma and delayed identification of spectrum of causes of acute abdomen in pregnancy ultimately resulting in maternal and foetal morbidity and mortality. This case was to identify the spectrum of causes, the clinical presentation and diagnostic dilemma of acute abdomen in pregnancy. We presented one of the unusual and rare cause of acute abdomen with hemoperitoneum. Patient underwent emergency laparotomy with peritoneal wash with no obvious bleeding cause but evidence pointing towards vascular tumour or sub-serosal fibroid. The diagnosis remained obscured. The dilemma was attributed to higher radiological imaging with possibility of Haemorrhagic corpus luteum and non-viable heterotopic pregnancy. The cause of bleeding could not be identified with higher imaging due to contraindicated use of contrast enhanced MRI/CT and other alternatives due to radiation exposure in pregnancy. Diagnosis and treatment of acute abdomen in pregnancy should be individualized for better prognosis. Good clinical acumen is essential for ordering early diagnosis and intervention in acute abdomen in pregnancy