This document discusses abdominal swellings that can occur during pregnancy. It describes how the location and diagnosis of abdominal swellings can be complicated by the growing uterus. The document outlines various potential causes of abdominal swellings originating from the abdominal wall, within the abdominal cavity, or from the retroperitoneal space. Specific masses that can occur in different abdominal regions are detailed. The document also discusses toxic megacolon and provides criteria for its diagnosis.

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.