scholarly journals Midgut Volvulus: A Rare but Fatal Cause of Abdominal Pain in Pregnancy—How Can We Diagnose and Prevent Mortality?

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Eelyn Chong ◽  
David S Liu ◽  
Neil Strugnell ◽  
Vishnupriya Rajagopal ◽  
Krinal K Mori
Keyword(s):  
Abdominal Pain ◽  
Rare Condition ◽  
Definitive Treatment ◽  
Fetal Mortality ◽  
Midgut Volvulus ◽  
Loss Of Life ◽  
Delay In Diagnosis ◽  
Life Threatening ◽  
Low Incidence ◽  
In Pregnancy

Midgut volvulus in pregnancy is rare but life-threatening, resulting in high maternal and fetal mortality. This surgical emergency commonly masquerades as symptoms of pregnancy, which together with its low incidence often leads to delay in diagnosis and definitive treatment. Here, we review the last three decades of the literature, discuss the challenges in managing this rare condition, and raise awareness among clinicians to minimise loss of life.

scholarly journals Intestinal Obstruction in Pregnancy: A Case Report

2013 ◽  
Vol 2013 ◽  
pp. 1-2 ◽  
Author(s):  
Shakina Rauff ◽  
Stephen Kin Yong Chang ◽  
Eng Kien Tan
Keyword(s):  
Computed Tomography ◽  
Abdominal Pain ◽  
Intestinal Obstruction ◽  
Surgical Intervention ◽  
Clinical Suspicion ◽  
Fetal Mortality ◽  
Delay In Diagnosis ◽  
Appropriate Treatment ◽  
Prompt Diagnosis ◽  
In Pregnancy

Background. Intestinal obstruction in pregnancy is uncommon. The condition is associated with significant maternal and fetal mortality. The delay in diagnosis is due to nonspecific symptoms and a disinclination to carry out radiologic investigations in pregnancy.Case. A 39-year-old lady at 32 weeks of gestation presented with abdominal pain and nausea. Her symptoms worsened during admission. A computed tomography (CT) scan showed dilated small bowel loops suggestive of intestinal obstruction. She eventually underwent a laparotomy as conservative measures failed.Conclusion. A high index of clinical suspicion is required to diagnose intestinal obstruction in pregnancy. Prompt diagnosis should be made and the appropriate treatment instituted. Surgical intervention should be performed if necessary as further delay only results in increased morbidity and mortality.

Midgut volvulus secondary to congenital malrotation in pregnancy

2020 ◽  
Vol 13 (5) ◽  
pp. e234664 ◽  
Author(s):  
Eelyn Chong ◽  
David S Liu ◽  
Vishnupriya Rajagopal ◽  
Neil Strugnell
Keyword(s):  
Perinatal Outcomes ◽  
First Trimester ◽  
Small Bowel Resection ◽  
Emergency Laparotomy ◽  
Midgut Volvulus ◽  
Threatening Condition ◽  
Life Threatening ◽  
Uncommon Condition ◽  
Adverse Perinatal Outcomes ◽  
In Pregnancy

Midgut volvulus complicating congenital malrotation is a rare but life-threatening condition that can occur in pregnancy. We present a case of intestinal infarction resulting from midgut volvulus in a healthy 32-week pregnant woman who underwent emergency laparotomy and small bowel resection in the setting of fetal death in utero. This case highlights several challenging issues in diagnosing and managing this uncommon condition which leads to increased adverse perinatal outcomes. Prompt investigation and definitive surgical treatment are required when pregnant women present with bilious vomiting and new-onset abdominal or back pain especially beyond the first trimester.

scholarly journals Pheochromocytoma in pregnancy: a case report and review of literature

2010 ◽  
Vol 3 (2) ◽  
pp. 83-85 ◽  
Author(s):  
J George ◽  
J Y L Tan
Keyword(s):  
Gestational Hypertension ◽  
Beta Blockers ◽  
Cardiovascular Complications ◽  
Definitive Treatment ◽  
Fetal Mortality ◽  
Optimal Timing ◽  
Tumour Resection ◽  
Urinary Catecholamines ◽  
Operative Control ◽  
In Pregnancy

Hypertension is a common problem in pregnancy that can result in significant maternal and fetal morbidity and mortality. The common causes include pre-eclampsia, gestational hypertension and essential hypertension. Although phaeochromocytoma is a rare cause of hypertension in pregnancy, it can lead to potentially life-threatening cardiovascular complications for the mother and increased fetal mortality if left undiagnosed and untreated. The diagnosis can be confirmed by measurement of plasma and urinary catecholamines and their metabolities followed by radiological localization of the tumour. Surgical resection of the tumour after adequate pre-operative control of hypertension using sequential alpha- followed by beta-blockers is the definitive treatment. In pregnancy, depending on the gestation at which diagnosis is made, the optimal timing for surgery is during the late first or early second trimester. When the pregnancy is more advanced, medical management followed by combined caesarean section and tumour resection closer to term is preferred.

scholarly journals Gastric volvulus is a rare and life-threatening abdominal pain

2021 ◽  
Vol 8 (11) ◽  
pp. 3492
Author(s):  
Raúl Omar Martínez Zarazúa ◽  
Hector Vergara Miranda ◽  
Rafael Sáenz Resendez ◽  
Cesar Adrián Sepulveda Benavides ◽  
Daniel Eduardo Saldívar Martínez
Keyword(s):  
Abdominal Pain ◽  
Anterior Abdominal Wall ◽  
Gastric Volvulus ◽  
Definitive Treatment ◽  
High Surgical Risk ◽  
Gastric Obstruction ◽  
Life Threatening ◽  
Acute Form ◽  
Gastric Ischemia ◽  
Prevention Of Recurrence

Gastric volvulus is a rare and life-threatening abdominal pain condition resulting from the stomach twisting on its own longitudinal (organo-axial) or transverse (mesentero-axial) axis. Gastric volvulus can be primary or secondary. Secondary is most commonly related to para-esophageal hernia. Gastric volvulus can have an acute or chronic presentation, the acute form presents abdominal pain with a risk of gastric ischemia with subsequent perforation. Diagnosis is made by imaging studies such as barium contrast studies in the upper digestive tract or abdominal and chest computed tomography (CT). CT of the abdomen and thorax is very useful in the diagnosis as it can demonstrate the abnormal position and gastric torsion The goal in the definitive treatment of gastric volvulus is resolution of gastric obstruction and prevention of recurrence. Performing volvulus reduction, repair of the concomitant cause (para-esophageal hernia), fundoplication and/or gastropexy to the anterior abdominal wall. Gastropexy is considered safe and effective in elderly patients with high surgical risk.

scholarly journals Spontaneous Haemoperitoneum in Pregnancy (SHiP) with Placenta Percreta in Bicornuate Uterus with Successful Pregnancy Outcome

2021 ◽  
Author(s):  
Jayasree Santhosh ◽  
Latha V. Kharka ◽  
Atheel Kamona ◽  
Sumaiya S. Al Amri
Keyword(s):  
Abdominal Pain ◽  
Caesarean Section ◽  
Iliac Fossa ◽  
Rare Condition ◽  
Placenta Percreta ◽  
Bicornuate Uterus ◽  
Lower Segment Caesarean Section ◽  
History Of ◽  
Intraperitoneal Bleeding ◽  
In Pregnancy

Intraperitoneal haemorrhage during pregnancy or postpartum without any history of trauma is termed Spontaneous Haemoperitoneum in Pregnancy (SHiP). This is a rare condition, causing significant morbidity and mortality for the mother and the neonate. We report a case of SHiP in a patient who presented to us at 31 weeks of gestation with right iliac fossa pain, pallor and tachycardia. Radiological investigations revealed intraperitoneal bleeding and a right adnexal haematoma. She was managed conservatively with blood transfusion and supportive care. At 36 weeks of gestation, lower segment caesarean section (LSCS) was done and a live baby with good Apgar score was delivered. Per-operatively, she was found to have a bicornuate uterus, placenta percreta at the junction of the horns and a right adnexal haematoma. This case highlights the significance of thorough evaluation of acute abdominal pain in pregnancy in avoiding unnecessary surgical intervention and iatrogenic prematurity. Keywords: Abdominal pain; Caesarean Section; Hemoperitoneum; Placenta accreta; Pregnancy.

scholarly journals A Case of Midgut Volvulus Associated with a Jejunal Diverticulum

2017 ◽  
Vol 2017 ◽  
pp. 1-3
Author(s):  
Joseph Gutowski ◽  
Rachel NeMoyer ◽  
Glenn S. Parker
Keyword(s):  
Abdominal Pain ◽  
Small Bowel ◽  
Internal Hernia ◽  
Midgut Volvulus ◽  
Current Case ◽  
Intermittent Abdominal Pain ◽  
Cat Scan ◽  
Jejunal Diverticulum ◽  
Life Threatening ◽  
Swirl Sign

Midgut volvulus in adults is a rare entity that may present with intermittent colicky abdominal pain mixed with completely asymptomatic episodes. This small bowel twist may result in complications of obstruction, ischemia, hemorrhage, or perforation. With a midgut volvulus, complications may be life-threatening, and emergent surgical intervention is the mainstay of treatment. This current case involves an 80-year-old woman with intermittent abdominal pain with increasing severity and decreasing interval of time to presentation. A CAT scan revealed mesenteric swirling with possible internal hernia. A diagnostic laparoscopy followed by laparotomy revealed a midgut volvulus, extensive adhesions involving the root of the mesentery, and a large jejunal diverticulum. The adhesions were lysed enabling untwisting of the bowel, allowing placement of the small bowel in the correct anatomic position and resection of the jejunal diverticulum. This is a rare case of midgut volvulus with intermittent abdominal pain, associated with jejunal diverticulum managed successfully. A midgut volvulus should be considered in the differential diagnosis of a patient who present with a small bowel obstruction secondary to an internal hernia, especially when a swirl sign is present on the CAT scan.

scholarly journals Wandering Spleen - A Possible Cause of Adrenal “Mass” - Case Report

2019 ◽  
Vol 0 (0) ◽  
Author(s):  
Slavica Markovic ◽  
Milan Paunovic ◽  
Biljana Vuletic ◽  
Zorica Raskovic ◽  
Gordana Kostic ◽  
...  
Keyword(s):  
Negative Attitude ◽  
Rare Condition ◽  
Good Health ◽  
Anterior Wall ◽  
Wandering Spleen ◽  
Anatomical Location ◽  
Ectopic Spleen ◽  
Life Threatening ◽  
Low Incidence ◽  
The Right

Abstract Wandering spleen is a very rare clinical condition characterized by spleen absence in the normal anatomical location in the upper left quadrant of the abdomen and its presence at another location in the abdomen or pelvis. The ectopic spleen is extremely rare in children, where its increased mobility is the result of a congenital disturbance of the fixation for the anterior wall due to the absence or weakness of the supporting ligaments. Wandering spleen is usually asymptomatic, but its torsion is possible, as well as infarction or rupture which demand an urgent diagnosis and surgical treatment. The diagnosis of wandering spleen can easily be overlooked due to low incidence and insufficient clinical experience, which multiplies patient’s risk from life-threatening conditions. We present a case of wandering spleen in an 11-year-old girl with acute abdominal pain, which after ultrasound examination raised suspicion on the right adrenal gland tumor. Additional diagnostics verified an ectopic spleen in the right adrenal box, after which the recommended preventive splenopexy was seriously considered. Due to the fixation of the vital spleen in the new position, but also the negative attitude of the parents towards the surgical intervention, clinical monitoring was selected, with exclusion of intense physical activity that carries the risk of traumatization of the spleen. As the girl has been in good health for over 3 years and without symptoms, we consider that the selection of conservative access although difficult, was correct. We hope that our experience in treating wandering spleen in girls will increase the number of valid facts about this rare condition.

scholarly journals Symptomatic Bochdalek Hernia in Pregnancy: A Rare Case Report

2017 ◽  
Vol 2017 ◽  
pp. 1-3
Author(s):  
Selçuk Yetkinel ◽  
Çağhan Pekşen ◽  
Remzi Kızıltan
Keyword(s):  
Case Report ◽  
Abdominal Distension ◽  
Recurrent Abdominal Pain ◽  
Intraabdominal Pressure ◽  
Fetal Mortality ◽  
Bochdalek Hernia ◽  
Delay In Diagnosis ◽  
Rare Case Report ◽  
Diaphragm Hernia ◽  
In Pregnancy

Introduction. Symptomatic Bochdalek hernia in pregnancy is quite rare. To the best of our knowledge, there are a total of 44 cases reported in the literature between 1959 and 2016 (Hernández-Aragon et al., 2015; Koca et al., 2016). Difficulty and delay in diagnosis may lead to life-threatening complications. Case Report. We report a case of Bochdalek hernia during the 30 gestational weeks’ pregnancy in whom pregnancy continued after surgical repair which resulted in term birth. Discussion. Bochdalek hernia is diagnosed with an incidence of 1 in 2200–12500 live births, while symptomatic diaphragm hernia is much less in adults. The actual incidence of diaphragmatic hernias during pregnancy is still unknown. Symptoms may include abdominal distension, recurrent abdominal pain, nausea, vomiting, inability to defecate, dyspnea, and chest pain. The patient with diaphragmatic hernia may be asymptomatic until the late weeks of gestation, as in our case, or herniation may occur during advanced gestational weeks with increased intraabdominal pressure. Conclusion. In conclusion, diagnosis of the diaphragm hernia during pregnancy is very rare. Diagnosis is rarer in symptomatic patients due to its rarity and the duration of diagnosis may, therefore, be delayed. Diaphragm hernia should be kept in mind in symptomatic patients due to its high maternal and fetal mortality rates.

scholarly journals Medical Management of Pyometra in the Delayed Postoperative Period

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Natalie A. Vukmer ◽  
Heather Urrego ◽  
A. Mitch Dizon
Keyword(s):  
Abdominal Pain ◽  
Uterine Cavity ◽  
Rare Condition ◽  
Operative Management ◽  
Uterine Perforation ◽  
Normal Female ◽  
Diffuse Abdominal Pain ◽  
Life Threatening ◽  
Timely Fashion ◽  
Hospital Stays

Pyometra is a rare condition in which purulent material becomes entrapped within the uterine cavity. If unrecognized in a timely fashion, life-threatening complications can arise. The following is a case report of a 50-year-old female who presented to the emergency department with abdominal pain and heavy vaginal bleeding. She was diagnosed with a pyometra based on imaging and treated conservatively with antibiotics. The patient ultimately had an uncomplicated hysterectomy with resolution of normal female pelvic anatomy prior to surgery. Pyometra should be considered when women present with diffuse abdominal pain or peritonitis. As demonstrated in this report, early detection and conservative management may help prevent serious complications such as uterine perforation, lead to shorter hospital stays, and result in safer operative management.

scholarly journals Pheochromocytoma during pregnancy - a rare diagnose with a complex multidisciplinary approach

2021 ◽  
Vol 10 (9) ◽  
pp. 3587
Author(s):  
Rita Silva ◽  
Catarina R. Carvalho ◽  
Madalena Andrade Tavares ◽  
Celia Pedroso ◽  
Paula Tapadinhas
Keyword(s):  
Multidisciplinary Approach ◽  
Gestational Hypertension ◽  
Cardiovascular Complications ◽  
Fetal Mortality ◽  
Common Causes ◽  
Threatening Condition ◽  
Fetal Complications ◽  
Life Threatening ◽  
The Common ◽  
In Pregnancy

Hypertension is a common problem in pregnancy that can result in significant maternal and fetal morbidity and mortality. The common causes include pre-eclampsia, gestational hypertension and essential hypertension. Although pheochromocytoma is a rare of hypertension in pregnancy, it can lead to potentially life-threatening cardiovascular complications for the mother and increased fetal mortality if left undiagnosed and untreated. Early diagnosis and timely, appropriate management reduce possible maternal and fetal complications. We report a case of a 32-week pregnant woman diagnosed with hypertension secondary to pheochromocytoma. An elective caesarian section was performed at 37 weeks of gestational age and underwent a laparoscopic left adrenalectomy with success. A multidisciplinary approach is of utmost importance and essential during the management of this life-threatening condition during pregnancy.

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