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      Midgut Volvulus in a Pregnant Patient Presenting With Abdominal Pain

      case-report

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          ABSTRACT

          Abdominal pain is a common symptom during pregnancy, but bowel obstruction as the cause is a rare phenomenon. Moreover, intestinal volvulus is an even more unusual cause of obstruction during pregnancy and normally involves the sigmoid colon. We report a unique case of midgut volvulus in a pregnant patient entering her third trimester who presented to the hospital with abdominal pain. Our case demonstrates the safety of computed topography in pregnancy while restricting radiation dose and highlights the need to have a high index of suspicion for bowel obstruction when approaching a pregnant patient with abdominal pain.

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          Physicians' perceptions of teratogenic risk associated with radiography and CT during early pregnancy.

          Kiran Chandra, Savithiri Ratnapalan, Nicole Bona … (2004)
          The objective of our study was to determine family physicians' and obstetricians' perceptions of the risk of major fetal malformations associated with exposure to radiation from radiography and CT during early pregnancy. Structured questionnaires were sent to 400 family physicians and 100 obstetricians selected randomly across Ontario, Canada. The physicians were informed about the 1-3% baseline risk for major malformations and were asked about their perceptions of the risk to the fetus associated with an abdominal radiograph and an abdominal CT scan during early pregnancy and whether they would recommend a therapeutic abortion after such exposure. Fifty-five percent (218/400) of the family physicians and 69% (69/100) of the obstetricians responded to our questionnaire. Forty-four percent of family physicians estimated the risk associated with an abdominal radiograph to be 5% or greater, and 61% estimated the risk associated with an abdominal CT scan to be 5% or greater. Eleven percent of obstetricians estimated the risk associated with radiographs to be 5% or greater (p < 0.001), and 34% estimated the risk associated with CT scans to be 5% or greater (p < 0.001). Among family physicians, 1% recommended an abortion if the fetus was exposed to radiation from radiography and 6% after exposure to radiation from CT. None of the obstetricians recommended an abortion after exposure to radiation from an abdominal radiograph, but 5% recommended an abortion after exposure to radiation from an abdominal CT scan in early pregnancy. Our survey shows that physicians who care for pregnant women perceive the teratogenic risk associated with an abdominal radiograph and an abdominal CT scan to be unrealistically high during early pregnancy. This misperception could lead to increased anxiety among pregnant women seeking counseling and to unnecessary terminations of otherwise wanted pregnancies. This perception of high teratogenic risk associated with radiation could also lead to a delay in needed care of pregnant women.
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            Management of acute abdomen in pregnancy: current perspectives

            Sanoop Zachariah, Miriam Fenn, Kirthana Jacob … (2019)
            Acute abdomen in pregnancy represents a unique diagnostic and therapeutic challenge. Acute abdominal pain in pregnancy can occur due to obstetric factors as well for reasons that are unrelated to pregnancy. The diagnostic approach of acute abdomen during pregnancy can be tricky owing to the altered clinical presentations brought about by the anatomical and physiological changes of gestation along with the reluctance to use certain radiological investigations for fear of harming the fetus. Delay in diagnosis and treatment can lead to adverse outcomes for both the mother and fetus. In this article, we attempt to review and discuss the various etiologies, the current concepts of diagnosis, and treatment, with a view to developing a strategy for timely diagnosis and management of pregnant women presenting with acute abdominal pain.
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              Small bowel obstruction in pregnancy is a complex surgical problem with a high risk of fetal loss.

              PJ Webster, MA Bailey, J. Wilson … (2015)
              Small bowel obstruction (SBO) in pregnancy is rare and is most commonly caused by adhesions from previous abdominal surgery. Previous literature reviews have emphasised the need for prompt laparotomy in all cases of SBO because of the significant risks of fetal loss and maternal mortality. We undertook a review of the contemporary literature to determine the optimum management strategy for SBO in pregnancy.
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                Author and article information

                Contributors
                Zilan X. Lin
                Frederick Yick
                Virendra Tewari
                Journal
                Journal ID (nlm-ta): ACG Case Rep J
                Journal ID (iso-abbrev): ACG Case Rep J
                Journal ID (coden): ACGCRJ
                Journal ID (publisher-id): AC9
                Title: ACG Case Reports Journal
                Publisher: Wolters Kluwer (Maryland, MD )
                ISSN (Electronic): 2326-3253
                Publication date Collection: February 2023
                Publication date (Electronic): 09 February 2023
                Volume: 10
                Issue: 2
                Electronic Location Identifier: e00983
                Affiliations
                [1 ]Division of Gastroenterology and Hepatobiliary Diseases, Westchester Medical Center, Valhalla, NY
                [2 ]Department of Medicine, Mount Sinai Hospital, New York, NY
                [3 ]Department of Gastroenterology and Hepatology, Rutgers New Jersey Medical School, Newark, NJ
                Author notes
                Correspondence: Virendra Tewari, MD ( virendra.tewari@ 123456wmchealth.org ).
                Article
                Publisher ID: ACGCR-22-0399 Accession ID: 00002
                DOI: 10.14309/crj.0000000000000983
                PMC ID: 9911195
                SO-VID: b2de8161-061f-49b9-bd7b-9bb3a5af0cd4
                Copyright © © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The American College of Gastroenterology.
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

                History
                Date received : 04 June 2022
                Date accepted : 09 January 2023
                Categories
                Subject: Case Report
                Subject: Small Bowel
                Custom metadata
                OPEN-ACCESS TRUE

                Keywords: bowel obstruction,midgut volvulus,pregnancy,third trimester
                Data availability:
                Keywords: bowel obstruction, midgut volvulus, pregnancy, third trimester

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