Abdominal apoplexy in late trimester of pregnancy: Case reports

Abstract

[Background] Abdominal apoplexy or Idiopathic Spontaneous Intraperitoneal Hemorrhage (ISIH) is rare and refers to intra-abdominal hemorrhage caused by spontaneous rupture of blood vessels in the abdominal cavity or retroperitoneum. The clinical diagnosis of abdominal apoplexy during pregnancy is rarer, and often made only after emergent exploratory laparotomy is performed for unstable vital signs and severe anemia. Affected by an enlarged uterus during pregnancy, the symptoms and signs of acute abdomen may be confused with placental abruption or other more common complications of pregnancy. [Case presentation] Both cases in the study showed that the main symptoms were abdominal pain, hypotension, nausea, vomiting, and other associated blood loss symptoms of varying degrees. Due to its sudden onset, this dangerous condition with no typical symptoms and signs can be easily misdiagnosed, two cases were given urgent surgery finally. At a 12-month follow-up, no abnormalities were observed during medical examinations of both mother and child. [Conclusions] The clinical diagnosis of abdominal apoplexy during pregnancy usually needs emergent exploratory laparotomy to find the hemorrhagic spot. We analyzed and summarized two cases of abdominal apoplexy in the late third trimester of pregnancy in and aims to provide certain clinical reference for surgeons when seeing the abnormal sustaining abdominal pain during pregnancy so that adverse pregnancy outcomes can be avoided.