Cecal volvulus in a multiple-gestation pregnancy.
BACKGROUND
Intestinal obstruction during pregnancy is rare, with volvulus being responsible for about 25% of cases.


METHODS
We present a case in which a woman in the 12th week of a twin gestation presented with abdominal pain and distension. She was initially diagnosed with an ileus, and radiological studies at the time were deferred. The patient's symptoms worsened, and eventually she was taken to surgery for a diagnostic laparoscopy, which revealed a cecal volvulus with ischemic changes. A right hemicolectomy with primary anastomosis was performed.


CONCLUSIONS
Volvulus in pregnancy carries a high mortality rate, often because diagnosis is delayed due to avoidance of radiography and because of similarity of symptoms to other clinical entities. A high index of suspicion for volvulus must be maintained when a pregnant patient presents with obstructive symptoms. Abdominal radiographs may be justified in aiding the diagnosis, and diagnostic laparoscopy is a viable alternative when the patient has an acute abdomen.
Chase
Daniel M
DM
From the Department of Surgery, Western Reserve Care System/Northeast Ohio Universities College of Medicine, Youngstown, Ohio.
Sparks
Dorothy A
DA
Dawood
Murtaza Y
MY
Perry
Earnest
E
D000328:Adult; D002429:Cecal Diseases / Q000175:diagnosis* / Q000601:surgery; D005260:Female; D006801:Humans; D045822:Intestinal Volvulus / Q000175:diagnosis* / Q000601:surgery; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis* / Q000601:surgery; D011272:Pregnancy, Multiple; D014427:Twins