Prof. M.C. Bansal

MBBS., MS. MICOG. FICOG

Ex Principal & controller

Jhalawar Medical college & Hospital.

M.G.M.C. & Hospital. Sitapura ., Jaipur

Abdominal Swellings=== Abdominal swelling can present in any stage of pregnancy.

In early pregnancy diagnosis is easy and as in case of non pregnant state as pregnant uterus is still in the pelvis . X Ray exposure / CAT should be avoided for diagnostic purpose.

As uterine height increases , abdominal swellings arising ., other organs will be displaced upward and laterally.

Signs of intra peritoneal inflammation are also likely to be altered., leading to miss guide the diagnosis which will increase the potential serious consequences.

Locations of Abdominal Swellings (A) Originating From abdominal Wall– Skin and its appendages,

subcutaneous tissue , Herniation of intra peritoneal contents.

( B )Abdominal swellings arising inside cavity---Generalised abdominal distension—Five “F” fat, fluid, faeces , flatus and fetus . Large fibroids or ovarian cyst, over distension of gravid uterus due to twins, hydraminos, monsters, hydatiform mole.

- Localized swellings -> (1)Mass in right hypochondrium-normal variant like Riedal’s lobe ,enlarged liver , distended gall bladder. (2)Masses in epigastrium->enlarged left lobe of liver , tumor of stomach ,/ cyst of pancreas.

(3) mass in left hypo chondrium->Enlargement of spleen , extension of mass from epigastrium.

(4) mass in lumber region-> enlargement of kidney,Extension of mass from hypochondrium , upward shifting of mass from iliac fossa due to enlarging and upward growth of gravid uterus.

Localized intra abdominal swelling-(5) Mass in umbilical quadrant-> Aortic aneurism ,mesenteric cyst ,moderate

splenomegaly.( 6) Right iliac fossa->Distended caecum ,appendicular abscess or

mucocele,Distension of terminal ileum , ileaocecal tuberculosis / amoeboma , enlarged ileoceacal lymph nodes ,Psoas abscess, IBS ,focal osteoma of illiac bones .

“ it is important to bear in mind as the fetal loss from less than 2 % if appendix is unrupture to almost 30% if it ruptures.” (7) Mass in Supra pubic region-> usually pelvic mass –along with gravid

uterus.( 8) Mass in Left Iliac Fossa-> inflammatory mass of diverticulitis

( C) Abdominal swelling arising from Retroperitoneal space -> Can arising from pancreas , kidney , lymph node , bones , fat , teratoma, adrenal gland tumor . Benign tumors in pregnancy are rare , but Most common tumors reported during pregnancy are liposarcoma ( malignant ) and lymphangioma ( benign ).

Toxic Mega Colon

Cases suffering from IBS may develop inflammation of terminal ileum which swells and can be palpated as a sausage shaped mass in right iliac fossa . It often lies in transverse position .Symptoms include fever , vomitings ,abdominal pain , diarrhea , rectal bleeding /mucous discharge and tenesmus .It may complicate –as abscess , toxic mega colon /obstruction. Diagnosis may be missed in pregnancy and in patient taking corticosteroids.

Criteria for diagnosis of toxic megacolon

(A) One of the following--

Dehydration , electrolyte imbalance , altered mental state ,hypotension.

( B )Three of the following—

Fever , Tachycardia > 120 HB /min, Leucocytosis ,anemia.

( C ) X-Ray findings of transverse colon – diameter greater than 6 cm.