title: Pregnant and severe acute abdominal pain: A surgical diagnostic dilemma.
abstract: Acute abdominal pain in pregnancy remains a surgical conundrum. A 25-year-old primigravid at 29 weeks gestation presented with a two-week history of epigastric pain, nausea and vomiting. She had a distended abdomen consistent with a full term gravid uterus; tender at the epigastric and right hypochondrium suggestive of small bowel obstruction or acute appendicitis. Abdominal ultrasound was inconclusive but abdominal Computed Tomography (CT) suggested small bowel volvulus. An exploratory laparotomy revealed a segmental jejunal volvulus and small bowel diverticulum contributing to the volvulus. A short segmental bowel resection was performed. Histopathology confirmed a Meckel's Diverticulum. The patient recovered well but underwent premature labour 10 days later. Small bowel obstruction secondary to Meckel's diverticulum is rare in pregnancy. In an acute gestational abdomen, clinical examination is key. Radiological imaging may be helpful, whilst surgical intervention is confirmatory and therapeutic in the event of an obstructive volvulus.
authors.affiliation: Upper Gastrointestinal, Bariatric and Metabolic Unit, Department of Surgery. Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia.
authors.forename: N R
authors.initials: NR
authors.lastname: Kosai
authors.affiliation: Upper Gastrointestinal, Bariatric and Metabolic Unit, Department of Surgery. Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia.
authors.forename: H
authors.initials: H
authors.lastname: Amin-Tai
authors.affiliation: Upper Gastrointestinal, Bariatric and Metabolic Unit, Department of Surgery. Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia.
authors.forename: H S
authors.initials: HS
authors.lastname: Gendeh
authors.affiliation: Obstetrics and Gynaecology Unit, Gleanegles Intan Medical Center, Kuala Lumpur, Malaysia.
authors.forename: S
authors.initials: S
authors.lastname: Salleh
authors.affiliation: Upper Gastrointestinal, Bariatric and Metabolic Unit, Department of Surgery. Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia.
authors.forename: R
authors.initials: R
authors.lastname: Reynu
authors.affiliation: Upper Gastrointestinal, Bariatric and Metabolic Unit, Department of Surgery. Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia.
authors.forename: M M
authors.initials: MM
authors.lastname: Taher
authors.affiliation: Institute of Translational Medicine, University of Liverpool, Liverpool, United Kingdom.
authors.forename: P A
authors.initials: PA
authors.lastname: Sutton
authors.affiliation: Upper Gastrointestinal, Bariatric and Metabolic Unit, Department of Anatomy. Universiti Kebangsaan Malaysia Medical Centre (UKMMC), Kuala Lumpur, Malaysia.
authors.forename: S
authors.initials: S
authors.lastname: Das
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000208:Acute Disease; D000328:Adult; D013505:Digestive System Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D008467:Meckel Diverticulum / Q000150:complications / Q000601:surgery*; D010808:Physical Examination; D011247:Pregnancy; D014057:Tomography, X-Ray Computed
keywords: Diverticulum; Obstruction; Pregnancy; Small bowel; Volvulus