Double Midgut Volvulus in Pregnancy: A Case Report of a Rare Intestinal Obstruction

Abstract

Intestinal obstruction secondary to volvulus is uncommon in pregnancy. Women with volvulus in pregnancy may present with vomiting, epigastric pain, and constipations which may mimic physiological changes in pregnancy or other common disorders such as malaria in pregnancy. In addition, there may be challenges with investigations such as ultrasound, X-ray, and magnetic resonance imaging which may not be readily available in low‑resource settings, thereby further delaying the diagnosis. We report the case of a young woman who  presented with epigastric pain and abdominal distention at 36-week gestational age. Urgent ultrasound scan revealed a viable gestation  at 35 weeks with grossly distended bowels and increased peristalsis. A diagnosis of intestinal obstruction in pregnancy was made. She  had an exploratory laparotomy and emergency Caesarean section. She was delivered of a live female baby and was found to have fibrous  adhesions between a segment of the terminal ileum, the uterus and the right appendages, the terminal ileum and proximal  jejunum were also twisted, respectively, and a strip segment of ileum was gangrenous. Adhesiolysis, detorsion of the two volvulus, and  resection and anastomosis of the bowel were done. Ten-day post exploration, she developed a complete wound dehiscence which was  immediately repaired and she was eventually discharged home after eight days. She was seen at the postnatal and surgical outpatient  clinics on two occasions at two and six-week postoperation, respectively, with no complaint and her wound had healed. She was  discharged from the outpatient clinic by the 6th week post surgery.