Department of Obstetrics and Gynaecology, Hereford County Hospital, Hereford, HR1 2ER, UK.
Arch Gynecol Obstet. 2011 Mar;283 Suppl 1:39-43. doi: 10.1007/s00404-010-1789-2. Epub 2010 Dec 12.
Mid-gut volvulus is a rare complication of pregnancy, where torsion of the small bowel around its mesentery can result in extensive bowel infarction. To our knowledge, there has been no previous reported case of mid-gut volvulus and mesenteric vessel thrombosis managed without bowel resection.
A 25-year-old woman presented at 35 + 3 weeks gestation with constant abdominal pain. There was no past medical history of abdominal surgery. The patient later developed feculent vomiting. Exploratory laparotomy revealed a mid-gut volvulus causing small bowel ischaemia, which extended from the duodenojejunal (DJ) flexure to the terminal ileum. There was also mesenteric arterial and venous thrombosis. A healthy baby girl was delivered by caesarean section and the mid-gut volvulus was reduced. Further, two re-look laparotomies confirmed viable bowel following detorsion. The mesenteric vessel thrombosis was treated with intravenous heparin. The patient went on to make a full recovery.
As shown in this case, the volvulus and mesenteric vessel thrombosis may occur during pregnancy even in patients without previous history of coagulopathies and abdominal surgery. It is difficult to make a clinical diagnosis, as the symptoms, physical signs and laboratory findings can be misleading. Therefore, a high index of suspicion is necessary for the early diagnosis of these conditions, as prompt treatment can prevent bowel resection and improve maternal and foetal outcomes.
中肠旋转不良是妊娠的罕见并发症，小肠围绕肠系膜扭转可导致广泛的肠梗死。据我们所知，以前没有报道过中肠旋转不良和肠系膜血管血栓形成而无需肠切除术的病例。
一名 25 岁女性在 35+3 周妊娠时出现持续性腹痛，无腹部手术史。患者随后出现粪便性呕吐。剖腹探查显示中肠旋转不良导致小肠缺血，从十二指肠空肠曲延伸至末端回肠。同时存在肠系膜动脉和静脉血栓形成。通过剖宫产分娩了一名健康的女婴，同时减轻了中肠旋转不良。进一步的两次剖腹探查确认在扭转复位后肠管存活。肠系膜血管血栓形成采用静脉肝素治疗。患者完全康复。
正如本例所示，即使在没有既往凝血功能障碍和腹部手术史的患者中，妊娠期间也可能发生旋转不良和肠系膜血管血栓形成。临床诊断困难，因为症状、体征和实验室检查结果可能具有误导性。因此，对于这些情况的早期诊断需要高度怀疑，因为及时治疗可以防止肠切除术并改善母婴结局。
