Midgut Volvulus in Disguise: Acute Abdomen in Early Pregnancy

Abstract

Small bowel obstruction (SBO) in pregnancy is a challenging diagnosis. Case rarity, non-specific presentations, and the non-practicality of using X-ray/gamma-ray imaging modalities in pregnancy contribute to the increased difficulty in timely diagnosing midgut volvulus during pregnancy, thereby increasing maternal and fetal morbidity. We report a case of midgut volvulus in a 39-year-old lady, gravida 3, para 2, with two previous cesarean sections. Her only presenting complaint was abdominal pain for three days with no other associated symptoms. The case was successfully diagnosed using magnetic resonance imaging (MRI) and subsequently treated surgically by segmental resection with side-to-side ileocecal anastomosis, thereby saving the mother and fetus. Clinicians should have a low threshold of suspicion of the varied causes of SBO in pregnancy, particularly in patients with prior abdominopelvic surgeries. Imaging is central to preoperative diagnosis, and MRI has gained popularity with safety and accuracy comparable to computed tomography. Management aims at minimizing maternal and fetal morbidity and mortality.