Osteitis pubis i osteomijelitis pubis u trudnoći – prikaz dviju bolesnica

Neven Tučkar, Ivka Djaković, Ida Marija Šola, Matej Mustapić, Ozren Grgić, Vesna Košec

Pubic pain frequently accompanies uneventful pregnancies and is a common symptom in pregnancy. Still, in some cases, especially when it is associated with walking difficulties, persistent and/or severe pubic pain, and inflammation that can be confirmed by laboratory parameters, it should be taken with additional caution. Differential diagnosis should include osteitis pubis, a non-bacterial, self-limited inflammation that leaves no permanent consequences, but also, more importantly, osteomyelitis of the pubic symphysis. This is a rare bacterial infection in pregnancy, important to be diagnosed in time and treated early and properly since it can leave serious long-term complications such as fistulas that require prolonged treatment and sometimes even surgery. A multidisciplinary approach is mandatory to exclude all the other potential causes of pubic pain and make a timely diagnosis of osteomyelitis. We present two patients with pubic pain during pregnancy, with two different diagnoses and treatment options, and a favorable outcome that was the result of a multidisciplinary approach

Pubična bol najčešće je prisutna u urednim trudnoćama i čest je simptom u trudnoći. Ipak, katkad, a osobito ako uzrokuje tegobe pri kretanju, jaka je i/ili perzistentna te ako je povezana s upalom dokazanom laboratorijskim parametrima, trebala bi uputiti na pojačan oprez. Diferencijalna dijagnoza trebala bi uključiti osteitis pubis – nebakterijsku, samoograničavajuću upalu pubične simfize koja ne ostavlja trajne posljedice, ali i puno važnije, osteomijelitis pubis – bakterijsku infekciju pubične simfize koja se rijetko vidi u trudnoći, a zakasnjelo dijagnosticiranje te kasno i neodgovarajuće liječenje mogu ostaviti dugoročne komplikacije kao što su fistule koje nalažu dugotrajno, katkad i kirurško liječenje. Multidisciplinarni pristup obvezatan je radi isključivanja svih potencijalnih uzroka pubične boli i ranog postavljanja dijagnoze osteomijelitisa pubične simfize. Prikazujemo dvije trudnice s pubičnom boli u trudnoći, no s različitom dijagnozom i liječenjem te povoljnim ishodom koji je rezultat multidisciplinarnog pristupa.