Exploratory laparotomy in a 28-year-old postpartum woman with unexplained mixed shock revealed congenital intestinal malrotation and midgut volvulus requiring bowel resection.
Case Report (n=1)
Non-obstetric causes such as intestinal malrotation should be considered in the differential diagnosis of postpartum shock when hemodynamic instability persists.
Abstract Background Postpartum shock typically prompts evaluation for certain obstetric (OB) causes such as hemorrhage, uterine atony, or amniotic fluid embolism. However, when there is a decline in hemodynamic stability, other etiologies must be considered. We present a case of mixed shock in a postpartum patient whose diagnosis was masked by a possible placental abruption. Case summary A 28-year-old woman, G1P0, at 28 weeks gestation, presented with abdominal pain and vomiting. Ultrasound revealed a hypoechoic retroplacental region concerning for abruption. She underwent an emergent cesarean section (CS) with initial postoperative improvement. However, the patient then developed new-onset hypotension (80s/50s) and tachycardia (110-120s), prompting further evaluation. Initial evaluation suggested hemorrhage, but after careful imaging review, an internal hernia with bowel obstruction and ischemic changes was found. An exploratory laparotomy revealed congenital malrotation with Ladd’s bands causing midgut volvulus and bowel ischemia involving the superior mesenteric artery distribution. She underwent adhesiolysis, bowel resection, and temporary abdominal closure. Postoperatively, she developed mixed hemorrhagic and septic shock and was required to remain on mechanical ventilation, vasopressors, and serial re-explorations of the abdomen. Conclusion This case highlights the importance of broadening and exploring the differential for postpartum shock, even in the context of OB etiologies. Physiological overlap between different types of shock can obscure non-obstetric causes. Intestinal malrotation in adult patients is rare, and pregnancy-associated hemodynamics and anatomical changes may increase the risk of herniation and volvulus. Early reconsideration of diagnosis and multidisciplinary collaboration were important to this patient’s survival. This case emphasizes the critical care principle of reassessing initial assumptions when instability persists. This abstract is funded by: None
Taha et al. (Fri,) conducted a case report in Postpartum shock and intestinal malrotation (n=1). Exploratory laparotomy and bowel resection was evaluated. Exploratory laparotomy in a 28-year-old postpartum woman with unexplained mixed shock revealed congenital intestinal malrotation and midgut volvulus requiring bowel resection.