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Midgut volvulus following cesarean section.

D M Coder, L J Schewitz, H C Falls

    Obstetrics and Gynecology
    |February 1, 1976
    PubMed
    Summary

    A rare case of midgut volvulus occurred in a woman 3 days postpartum after cesarean section due to a congenital issue. Surgical intervention saved the patient, highlighting the need for awareness and prompt management of such obstetric emergencies.

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    Area of Science:

    • Gastroenterology
    • Surgical Pathology
    • Obstetrics & Gynecology

    Background:

    • Midgut volvulus is a rare surgical emergency, often congenital, involving the twisting of the small intestine around its mesentery.
    • Pregnancy and the postpartum period can present unique challenges for diagnosing and managing gastrointestinal emergencies.
    • Congenital anomalies of the mesentery, such as excessive length, predispose individuals to volvulus.

    Observation:

    • A 27-year-old primipara developed acute abdominal pain and signs of bowel ischemia three days following a cesarean section.
    • Clinical presentation suggested a catastrophic intra-abdominal event, necessitating urgent surgical exploration.
    • Intraoperative findings revealed extensive midgut volvulus and gangrene secondary to a congenitally elongated mesentery.

    Findings:

    • Complete small bowel resection, preserving only 12 inches of jejunum, was performed to address the gangrenous bowel.
    • The patient survived the extensive resection and the acute event, indicating the possibility of recovery even with significant bowel loss.
    • Review of existing literature on pregnancy-associated volvulus cases was conducted.

    Implications:

    • This case underscores the importance of considering rare gastrointestinal emergencies in the differential diagnosis of postpartum abdominal pain.
    • Early recognition and surgical intervention are critical for improving outcomes in midgut volvulus, even in the postpartum setting.
    • Understanding the role of congenital mesenteric abnormalities is key for potential prevention and tailored treatment strategies in at-risk individuals.

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