Liver dysfunction during pregnancy needs to be differentiated between various causes

Abstract

 We report a case of a patient who was referred for hepatic dysfunction during pregnancy and diagnosed with maternal intestinal obstruction due to malrotation of intestine. The patient was 27 years old, in her first pregnancy, who conceived spontaneously, and her previous physician managed her pregnancy. She had nausea and anorexia from the 30th week of pregnancy and lost 5 kg of weight from the 31st to 33rd week of pregnancy. The gastroenterologist pointed out liver dysfunction and referred her to our hospital at 33 weeks and 5 days gestation. Maternal ultrasound showed dilatation of the upper gastrointestinal tract, so a contrast-enhanced CT was performed. CT showed no abnormality in the liver, but intestinal malrotation, torsion, and obstruction were indicated. No intestinal strangulation was observed, and her symptoms and liver dysfunction slowly improved with intravenous nutrition and a nasogastric tube. However, her distress increased, and a cesarean section was performed at 35 weeks and 3 days of pregnancy. Intraoperative observation revealed intestinal obstruction due to malrotation, but it was resolved spontaneously. The patient resumed oral intake and was discharged on postoperative day 10. The patient was considered to have developed liver dysfunction due to persistent malnutrition, and it was the result of intestinal obstruction, with the background of malrotation, due to compression against the pregnant uterus. If liver dysfunction occurs during pregnancy and the upper gastrointestinal tract is dilated, as in this case, intestinal obstruction is a differential.