We present the case of a 25 year old lady from Papua New Guinea who was admitted to the Cairns base hospital (CBH) with a 3 day history of abdominal pain and distension on a background of being 20 weeks pregnant. She had a slightly elevated white cell count upon admission, was haemodynamically stable and tolerating oral diet. The patient had last passed a bowel motion 2 days prior.
Plain abdominal X-ray and chest X-ray showed mild gaseous distension of her small bowel and right colon. Her admission diagnosis was possible abdominal tuberculosis (TB) given she had previous TB and was from an endemic area. On day 3 of her admission she became tachycardic and tachypnoeic with a grossly distended abdomen and worsening abdominal pain. She was febrile with a white cell count of 19 x 109/L cells, lactate 3.2 mmol/L and haemoglobin of 126 g/L. An urgent MRI of her abdomen was performed, showing a likely large bowel volvulus with associated free fluid, but no perforation (Fig. 1, Fig. 2).
Given the patients worsening clinical condition and imaging findings she was taken for an urgent laparotomy. A splenic flexure volvulus with gangrenous colon was found (Fig. 3, Fig. 4) and the patient underwent a left hemicolectomy and end colostomy. The decision was made not to perform a primary anastomosis given her clinical condition and the risk presented by a potential anastomotic leak adjacent to the gravid uterus. She had pre and postoperative obstetric team review. The patient recovered well and delivered a healthy baby at full term 4 months later. She underwent a reversal of her colostomy 6 months later and was discharged home without incident. Happily both mother and baby were both well at follow up in the outpatient clinic.