THE earliest recorded case of intestinal obstruction in pregnancy was by Houston in 1830. Pregnancy ileus, as a cause of intestinal obstruction, has been adequately described in world literature, and Slemon and Williams (1938) published over 1000 references. Hansen (1941) collected 84 cases of intestinal obstruction in pregnancy in the English literature and added a case of his own. Since that time other cases have been recorded by Andreasen (1941)~ Barone, Power, and Kuhn (1941), Hipsley (1942), James (1946, I~SO), Siege1 and Pleshette (1948), Matthews and Mitchell (1948), and Baker and Lister (1953). The comparative rarity of this condition has stimulated the authors to describe a further case i n which the precise nature of the malrotation causing volvulus was ascertained at operation.
CASE REPORTMrs. J. C., aged 21, a primigravida 32 weeks pregnant, was admitted to hospital on Aug. 30, 1953. The pregnancy had been uneventful until 7 days before admission, when she began vomiting, which became profuse and which was accompanied 3 days later by seyeFe colicky upper abdominal pains, not uterine in orign. She had not had a bowel action for 5 days. She had been under observation at the R.A.F. Hospital, Rostrup, for 2 days and had been given sedatives, and 3 pints of glucose saline to combat dehydration.On examination she looked ill, was vomiting, and complained of pain; her tongue was moist but furred. The temperature was gg" F. and pulse-rate g41min.; blood-pressure was 140/80. There was no visible peristalsis, but the upper abdomen was distended and hyperresonant. The fundus of the uterus was z in. above the umbilicus. The right hypochondrium was tender, and faint bowel-sounds were heard, which were not obstructive in character. The uterus was contracting feebly, but the contractions were not related to the attacks of abdominal pain. The rectum was empty and ballooned, and there was tenderness on pressure over the cervix.After 4 hours' observation, as her condition was not improving, a laparotomy was advised. The pre-operative diagnosis had not been established, but the differential diagnosis rested between intestinal obstruction, acute appendicitis, salpingitis, torsion of an ovarian cyst, and pregnancy i1eus.-AT OPERATION (D. E. S. and T. McG. McN.).-Under general ansesthesia the abdomen was explored through a long right paramedian incision. The crecum, ascending colon, and one-third of the transverse colon were enormously distended, bloodless, and a volvulus had occurred round the pedicle of the ileocolic and right colic arteries. A derangement of intestinal rotation was recognized, the transverse colon passing through a gap behind the superior mesenteric artery and root of the mesentery (Fig. 220). The pedicle composed of the ileocolic and right colic arteries was ligated and the nonviable portion of the large gut, together with the terminal 10 in. of the ileum, was resected. The proximal end of the transverse colon was released from the gap in the root of the mesentery and invaginated. The patient's poor con...
