ALTHOUGH the incidence of intestinal obstruction in pregnancy appears to be increasing, it is still a sufficiently rare event for many junior hospital doctors and some consultants to have never seen a case. CASE REPORTS Case 1The patient was 34 years old, at 26 weeks in her second pregnancy. The only significant past history was of an appendicectomy before the birth of her first child. She gave a 2 hour history ofsevere colicky upper abdominal pain and had vomited before admission. She localised the pain poorly to the entire upper abdomen with radiation into the back and both loins. There had been no urinary symptoms and no vaginal bleeding. She had been constipated throughout the pregnancy, but there had been no recent change. On examination she was obviously distressed with the pain, but her colour was good, her pulse rate 70 beatsi min and her blood pressure and temperatur: normal. The abdomen was not distended other than by the pregnancy, but there was generalised tenderness to palpation in the entire upper abdomen and bilateral loin tenderness, greater on the right than the left. There was no guarding or rebound tenderness and bowel sounds were reduced. Palpation of the uterus was dificult because of tenderness, but it was soft and did not appear to be intrinsically tender. The uterine size was compatible with the dates and the fetal heart ratc was normal. Pelvic and rectal examinations were normal. No abdominal radiograph was taken. White cell count was 10.5 x 10y/l. Urine analysis and microscopy and serum amylase were normal.She was initially managed conservatively. Later in the day the pain localised to the right hypochondrium and vomiting recurred. Despite the continuing normality of the vital signs, she was clearly not improving and a provisional diagnosis was made of intestinal obstruction, probably due to adhesions from the previous appendicectomy.A laparotomy through an upper right paramedian incision was performed and an extensive volvulus of the small b w e l was revealed. The bowel had twisted five times around the superior mesenteric artery and was gangrenous I 0 cm from the duodenal-jejunal Hexure to 50 cm from the ileocaecal valve. There were no adhesions. The gangrenous buwel was resected and end-to-end anastomosis perlormed. Cefoxitin, I g 8 hourly was given i.v. for 5 days and the patient made an uneventful recovery, bring discharged on the fourteenth day. The pregnancy continued normally to a spontaneous delivery at term of a live male baby weighing 3.2 kg. Case 2The patient was 19 year, old, at 29 weeks in her first pregnancy. She had a past history of left nephrectomy and partial right nephrectomy as a neonate for congenital hydronephrosis, and had been treated for recurrent urinary tract infections. She had several episodes of abdominal pain before and during the pregnancy which settled with conservative treatment. She gave a 4 8 hour history of continuous lower abdominal and back pain. nausea and vom:!ing. On examination she was flushed, pulse !ate was 100 beatslmin, temperature and blo...
Introduction:Diverticulosis is considered to be mainly a problem of old age, with a prevalence of 35-50%. About 10-25% of patients with diverticulosis will develop diverticular disease compilation in their lifetime. The clinical presentation of diverticular disease depends on the severity of the inflammatory process and whether complications are present. Complicated diverticulitis refers to the presence of perforation, obstruction, bleeding and abscess or fistula formation. Between 25 and 55% of the patients with complicated diverticulitis will require surgery during their initial hospitalization. 1,2 The first attack of uncomplicated diverticulitis is treated conservatively. Sigmoid resection is indicated for
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