A Case of Postpartum Midgut Volvulus Managed through Massive Intestinal Resection

Abstract

We report a case of a 33-year-old female patient. At midnight, 18 h after delivery, she experienced a sudden onset of cardiac pain, followed by bilious vomiting. Despite treatment, the pain gradually increased, and the patient went into shock in the early morning on the next day, 6 h after the pain onset. Computed tomography revealed a whirl sign with an axis of the distended superior mesenteric vein and marked dilatation of the intestine. An emergency laparotomy was immediately performed, and intraoperative findings confirmed the diagnosis of midgut volvulus associated with intestinal malrotation. Since the tortuous intestine was necrotic owing to the impaired blood flow, we resected the right colon approximately 20 cm from the origin of the small intestine and reconstructed the small intestine and transverse colon by anastomosis. The patient's condition improved following intraoperative and postoperative intensive care, and she was discharged home on postoperative day 54 after central venous nutrition was introduced for short bowel syndrome, which is associated with massive intestinal resection. The incidence of midgut volvulus in the early postpartum period is extremely rare. Further, the condition is difficult to diagnose and is fatal ; hence, we report this case with a literature review.