A very rare case of volvulus of ileocecal following congenital band, presenting with cyanosis and shock in post-partum period

سال انتشار: 1398
نوع سند: مقاله کنفرانسی
زبان: انگلیسی
مشاهده: 345

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شناسه ملی سند علمی:

PNMED07_006

تاریخ نمایه سازی: 18 تیر 1398

چکیده مقاله:

Intestinal obstruction in pregnancy is still uncommon. The diagnosis of this condition is often delayed because the signs and symptoms of intestinal obstruction are mistaken for hyperemesis, placental abruption or ruptured uterus.Case Report The patient was 30-year-old gravida 1, twin pregnancy with 23 weeks of pregnancy. Her complain was mild vague abdominal pain, nausea and returning saliva and fluid. Since two months ago, the patient regularly returns saliva and fluid in a container, but no vomiting bile. A month before referring due to these signs, and diagnosis if appendicitis, she underwent appendectomy, but her symptoms did not improve. The patient s medical history, antepartum course, and physical examination, were uncomplicated. She was in active phase of labor. 4 hours after delivery the patient was cyanotic, BP: 50/undetectable diastole. Three Liter serum ringer and normal saline were perfused the BP became 70/50. Ultrasonography appeared huge fluid in abdomen. During laparotomy, a long ileocecal segment was observed to be cyanotic. Cecum and ileum were not fixing. A complete volvulus of dilated ileum was identified around the congenital band that predisposed to volvulus. About 2000 ml serosanguinous liquid was removed from peritoneal cavity. After resection of band and detorsion of ileocecal segment, some part of ileum within 20 minutes recovered then we observed another parts. Finally, 90 cm long cyanotic segment resected and ileostomy was performed. Post-operative course was uneventful and anastomosis was performed after 3 months. Discussion Volvulus in the postpartum period, as in this case, is exceedingly rare, but risk is thought to be increased from distortion of the colon occurring from rapid change of uterine size following delivery. The triad of symptoms associated with volvulus is traditionally pain, distention, and obstipation. The diagnosis of volvulus in the postpartum period requires a high index of suspicion and it has been shown that prompt intervention is the best predictor of improved patient outcomes.

نویسندگان

Mahboobeh Shirazi

MD, Perinatologist, Associate Professor, Maternal, Fetal and Neonatal Research Center, Tehran University of Medical Sciences, Yas Hospital, Tehran-Iran