Delayed diagnosis of bowel infarction secondary to maternal midgut volvulus at term

Background: Intestinal volvulus is responsible for 25% of acute bowel obstructions in pregnant women but only 3-5% in nonpregnant patients. Pregnancy may hinder early diagnosis. Case: A woman in early labor subsequently developed hypotension and a nonreassuring fetal heart rate tracing. Emergency cesarean was performed and a live infant was born. At surgery, the patient was noted to have ascites, necrotic bowel, and a congenital gut malrotation with a complete midgut volvulus. Several congenital peritoneal bands were lysed, the volvulus was reduced, and 184 cm of small bowel were resected. Conclusion: This patient represents a case of midgut volvulus with bowel infarction and necrosis secondary to congenital malrotation of the gut.