Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Aug 26, 2020; 8(16): 3553-3559
Published online Aug 26, 2020. doi: 10.12998/wjcc.v8.i16.3553
Intestinal obstruction in pregnancy with reverse rotation of the midgut: A case report
Xin-Yu Zhao, Xin Wang, Chun-Qiang Li, Qi Zhang, An-Qi He, Gang Liu
Xin-Yu Zhao, Xin Wang, Chun-Qiang Li, Qi Zhang, An-Qi He, Gang Liu, Department of General Surgery, Tianjin Medical University General Hospital, Tianjin 300052, China
Author contributions: Zhao XY designed and wrote the report; Wang X and Liu G reviewed the manuscript for intellectual content and revised the entire work; Li CQ, Zhang Qi and He AQ performed the histological assessments and evaluations; Zhao XY, Wang X, Liu G, Li CQ, Zhang Qi and He AQ were responsible for the patient’s therapy and follow-up, and revised the paper.
Informed consent statement: The patient provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Gang Liu, MD, PhD, Professor, Surgeon, Department of General Surgery, Tianjin Medical University General Hospital, No. 154 Anshan Road, Heping District, Tianjin 300052, China. landmark1503@sina.com
Received: May 1, 2020
Peer-review started: May 1, 2020
First decision: May 21, 2020
Revised: May 30, 2020
Accepted: July 17, 2020
Article in press: July 17, 2020
Published online: August 26, 2020
Processing time: 115 Days and 16.1 Hours
Abstract
BACKGROUND

Reverse rotation of the midgut is a rare type of intestinal malrotation. Volvulus of the right colon or entire midgut, stenosis of the transverse colon and obstruction of the duodenojejunal junction are common complications of reverse rotation. In this study, we report the first case of intestinal obstruction associated with reverse rotation in pregnancy.

CASE SUMMARY

A 31-year-old woman at 36+2 wk gestation presented to the emergency department with progressive abdominal cramping, nausea and bilious vomiting. Abdominal ultrasound scanning showed dilatation of the bowel. Computed tomography scanning revealed features of reverse rotation of the midgut with intestinal volvulus. After consultation with the obstetrician, the pregnancy was terminated and exploratory abdominal surgery was performed. Intra-operatively, it was found that the mesentery of the colon and small intestine was insufficiently attached. The right colon and the small intestinal mesentery was twisted, and intestinal necrosis was observed. The duodenum and duodenojejunal junction were curved in front of the transverse colon, and the transverse colon passed through the tunnel behind the mesenteric root. Intestinal reverse rotation with volvulus was confirmed. The ‌necrotic intestine was resected and small intestine mesenteric reconstruction was performed. The patient recovered after surgery. After leaving the hospital, the patient and her daughter remained well during an 8-month follow-up period.

CONCLUSION

We report the diagnosis, treatment and etiology of a pregnant patient with intestinal obstruction due to reverse rotation of the midgut. For similar cases, appropriate diagnosis and treatment should be carried out according to the condition of the fetus and pregnant woman.

Keywords: Congenital intestinal malrotation; Volvulus; Reverse rotation of the midgut; Intestinal obstruction; Pregnancy; Case report

Core tip: Reverse rotation of the midgut is the rarest type of intestinal malrotation, accounting for approximately 2%-4%. The most common feature is that the transverse colon lies behind the superior mesenteric artery and the duodenum is located in front of the superior mesenteric artery. In this study, we report the case of intestinal obstruction associated with reverse rotation of the midgut in pregnancy. Due to reverse rotation, the patient had insufficient attachment of the ascending colon and small bowel mesentery. As the uterus enlarged, the intestinal canal shifted, causing intestinal volvulus and obstruction. To our knowledge, this is the first report of a pregnant patient with reverse rotation of the midgut.