Portal de Periódicos da CAPES

Massive midgut volvulus during pregnancy

1997; Informa; Volume: 17; Issue: 6 Linguagem: Inglês

10.1080/01443619768687

1364-6893

A. D. Barata D. J. Kusnetzoff,

Pediatric Hepatobiliary Diseases and Treatments

3 . Four hours after admission, the patient had become oliguric. Abdominal radiographs showed dilated loops of bowel and air-¯ uid levels. The fetal heart was not heard. Surgical consultation was obtained and intesti- nal obstruction and septic shock diagnosed. Six hours after admission, an exploratory laparotomy was per- formed. The abdomen contained a large volume of dark blood and purulentuid. The entire small bowel and right colon up to the mid-transversecolon were distended, cyanotic and necrotic. The small bowel was twisted 360°counterclockwise, beginning 30 cm from ligament of Treitz up to terminal ileum. A 270° clockwise second volvulus was present from the beginning of the right colon to the mid-transverse colon. The superior mesenteric artery and vein were thrombosed, and pulses were absent. Caesarean sec- tion was performed and a 2700 g stillborn fetus was delivered. All involved bowel was resected; a jejunos- tomy and a large bowel mucous ® stula were created. Fetal autopsy revealed acute tubular necrosis and intrahepatic haemorrhage. The patient was given total parenteral nutrition as an in-patient, which was continued on an out-patient basis. She was readmitted three times with catheter- related sepsis and acid-base inbalances. The patient died 10 months after surgery as a result of septic shock and acute renal failure.