1. Prof. M.C. Bansal
MBBS., MS. MICOG. FICOG
Ex Principal & controller
Jhalawar Medical college & Hospital.
M.G.M.C. & Hospital. Sitapura ., Jaipur

2. 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.

4. 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.

5. 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 ).

6. 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.

7. 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.