No abstract

Small intestine ischaemia caused by volvulus is difficult to diagnose during pregnancy, as the signs and symptoms may be masked by pregnancy. An early diagnosis and a prompt surgical intervention is necessary, as morbidity and mortality of this disorder are significant. We are presenting a case of a 35-year-old pregnant woman with volvulus of small bowel. CASe RepoRTA 35-year-old woman who was in 32 nd week of gestation, presented to our Emergency Department with severe abdominal pain and nausea. The chief complaint was periumbilical pain of 2 days duration, which was of colicky in nature, which spread to the whole of the abdomen. She also reported of constipation for 1 day and she vomited semisolid particles twice after her admission. On admission, her vitals were found to be not stable and her blood pressure was not recordable. On clinical examination, her abdomen was found to be diffusely tender, with a 32 week gravid uterus and no foetal activity, which were confirmed on doing an emergency ultrasound screening.Laboratory investigations revealed increased blood urea nitrogen and creatinine levels. Patient was stabilized after giving adequate fluid and electrolyte therapy. An emergency laparotomy was done by making a midline incision. 200-300 ml of blood and clot were evacuated. A stillborn foetus was delivered .The death of the foetus was related to toxicity caused by volvulus and foetus was fresh dead at the time of surgery [Table/ Fig-1]. A small intestine volvulus in anti clockwise direction, 60 cm from the Treitz ligament, which spared 10 cm of the terminal ileum, was seen. The bowel was dark and oedematous, which indicated gangrene [Table /Fig-2,3]. Resection of the gangrenous bowel and end to end jejunoileal anastomosis were done. The post-operative period was uneventful. The patient has been followed up in our Outpatients Department for the past [ DiSCuSSionA surgically acute abdomen in pregnancy must be diagnosed early and accurately, as a prompt treatment is necessary, to prevent morbidity and mortality of the patient. It is difficult to diagnose an acute surgical abdomen in pregnancy, due to the increasing size of the uterus and the subsequent dislocations of the intra abdominal organs, high prevalence of hyperemesis gravidarum and abdominal pain in the normal obstetric population, lack of basic facilities for