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Delayed diagnosis of bowel infarction secondary to maternal midgut volvulus at term
A M Ventura-Braswell1, A J Satin, K Higby
1Department of Obstetrics and Gynecology, Wilford Hall Medical Center/Brooke Army Medical Center/Darnall Army Community Hospital, San Antonio, Texas, USA.
Background:
Intestinal volvulus is responsible for 25% of acute bowel obstructions in pregnant women but only 3-5% in nonpregnant patients. Pregnancy may hinder early diagnosis.
Case:
A woman in early labor subsequently developed hypotension and a nonreassuring fetal heart rate tracing. Emergency cesarean was performed and a live infant was born. At surgery, the patient was noted to have ascites, necrotic bowel, and a congenital gut malrotation with a complete midgut volvulus. Several congenital peritoneal bands were lysed, the volvulus was reduced, and 184 cm of small bowel were resected.
Conclusion:
This patient represents a case of midgut volvulus with bowel infarction and necrosis secondary to congenital malrotation of the gut.