title: Mid-gut volvulus and mesenteric vessel thrombosis in pregnancy: case report and literature review.
abstract: BACKGROUND
  Mid-gut volvulus is a rare complication of pregnancy, where torsion of the small bowel around its mesentery can result in extensive bowel infarction. To our knowledge, there has been no previous reported case of mid-gut volvulus and mesenteric vessel thrombosis managed without bowel resection.
  
  
  METHODS
  A 25-year-old woman presented at 35 + 3 weeks gestation with constant abdominal pain. There was no past medical history of abdominal surgery. The patient later developed feculent vomiting. Exploratory laparotomy revealed a mid-gut volvulus causing small bowel ischaemia, which extended from the duodenojejunal (DJ) flexure to the terminal ileum. There was also mesenteric arterial and venous thrombosis. A healthy baby girl was delivered by caesarean section and the mid-gut volvulus was reduced. Further, two re-look laparotomies confirmed viable bowel following detorsion. The mesenteric vessel thrombosis was treated with intravenous heparin. The patient went on to make a full recovery.
  
  
  CONCLUSIONS
  As shown in this case, the volvulus and mesenteric vessel thrombosis may occur during pregnancy even in patients without previous history of coagulopathies and abdominal surgery. It is difficult to make a clinical diagnosis, as the symptoms, physical signs and laboratory findings can be misleading. Therefore, a high index of suspicion is necessary for the early diagnosis of these conditions, as prompt treatment can prevent bowel resection and improve maternal and foetal outcomes.
authors.affiliation: Department of Obstetrics and Gynaecology, Hereford County Hospital, Hereford, HR1 2ER, UK.
authors.forename: Losa Hao
authors.initials: LH
authors.lastname: Shui
authors.forename: Junaid
authors.initials: J
authors.lastname: Rafi
authors.forename: Allan
authors.initials: A
authors.lastname: Corder
authors.forename: David
authors.initials: D
authors.lastname: Mowbray
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D000925:Anticoagulants / Q000627:therapeutic use; D002585:Cesarean Section; D005260:Female; D006493:Heparin / Q000627:therapeutic use; D006801:Humans; D045822:Intestinal Volvulus / Q000175:diagnosis* / Q000601:surgery; D008638:Mesenteric Arteries; D008641:Mesenteric Vascular Occlusion / Q000188:drug therapy / Q000209:etiology*; D008642:Mesenteric Veins; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis* / Q000628:therapy; D013927:Thrombosis / Q000175:diagnosis* / Q000188:drug therapy; D014839:Vomiting / Q000209:etiology
chemical_list: D000925:Anticoagulants; D006493:Heparin