Uncommon Cause Of Abdominal Pain Research Articles

Prevalence of SIRS with primary epiploic appendagitis.

Primary epiploic appendagitis (PEA) is not an uncommon cause of abdominal pain. The systemic inflammatory response syndrome (SIRS) criteria have high sensitivity for early detection of inflammation and infection. To date, there is limited data about the association between SIRS and PEA. The aims of this retrospective study were to evaluate the prevalence of SIRS response and its clinical relevance in patients diagnosed with PEA within a large tertiary hospital network. A retrospective study was performed on all consecutive adult patients who presented to four major emergency departments with CT-confirmed PEA from 01 January 2022 to 27 March 2023. The fulfilment of SIRS criteria, hospital admission rate and treatments provided were analysed for these patients. Seventy-three patients had CT-confirmed PEA. Seventeen patients (23.2%) with PEA were SIRS positive. The hospital admission rate in the SIRS group trended higher than the non-SIRS group (odds ratio of 2.51, 95% CI (0.75, 8.39)). The odds of having an associated radiological comorbidity unrelated to PEA were 18.7 times higher in the SIRS positive group. Fifty-seven (78%) patients were discharged home, and 16 (22%) patients were admitted into hospital. Nearly all patients were treated conservatively (98.6%). PEA patients with SIRS response trend towards a higher hospital admission rate and are significantly more likely to have other radiological comorbidities than non-SIRS patients. It is important to look for other pathological conditions in a SIRS positive patient with a CT-diagnosis of PEA.

Rectus Sheath Hematoma in a Patient with Dual-Antiplatelet Therapy Including Ticagrelor: A Case Report.

Rectus sheath hematoma (RSH) is an uncommon cause of abdominal pain associated with several risk factors including trauma, asthma, chronic obstructive pulmonary disease, pregnancy, and anticoagulation as it can be iatrogenic. Dual-antiplatelet therapy (DAPT), combined usage of a P2Y12 receptor inhibitor and aspirin, is a cornerstone treatment for patients with acute coronary syndromes. Ticagrelor is a P2Y12 receptor inhibitor with several adverse hemorrhagic complications. An 86-year-old male patient was admitted to the emergency department with abdominal pain and a palpable abdominal mass at the left upper quadrant of the abdomen. His medical history revealed coronary artery disease with medications including acetylsalicylic acid and ticagrelor. Contrast-enhanced abdominal computed tomography revealed RSH. The patient was treated conservatively with bed rest and analgesia. DAPT is an essential component of the management of acute coronary syndromes to prevent recurrent cardiac thrombotic events. However, hemorrhagic complications such as RSH may be encountered with DAPT. Emergency medicine physicians and cardiologists should keep in mind RSH in patients presenting with abdominal pain and using DAPT with ticagrelor.

A Case of Epiploic Appendagitis after COVID-19

Acute epiploic appendagitis is an uncommon cause of abdominal pain resulting from appendageal ischemia caused by torsion or thrombosis of the draining vein. It is frequently misdiagnosed as acute appendicitis or diverticulitis. The coronavirus disease 2019 (COVID-19) pandemic has changed how this rare disease is diagnosed. There was a report of a young men diagnosed with COVID-19 and epiploic appendagitis as a rare cause of abdominal pain. In addition, a 50-year-old men was diagnosed with epiploic appendagitis during the treatment of COVID-19. This paper reports the case of a 53-year-old men who presented with right lower quadrant abdominal pain after COVID-19 and was diagnosed with acute epiploic appendagitis by computed tomography image findings. The thrombotic condition of COVID-19 may contribute to acute appendagitis, but more studies are needed to confirm this hypothesis.

Epilepsy and the gut: Perpetrator or victim?

The brain and the gut are linked together with a complex, bi-path link known as the gut-brain axis through the central and enteric nervous systems. So, the brain directly affects and controls the gut through various neurocrine and endocrine processes, and the gut impacts the brain via different mechanisms. Epilepsy is a central nervous system (CNS) disorder with abnormal brain activity, causing repeated seizures due to a transient excessive or synchronous alteration in the brain’s electrical activity. Due to the strong relationship between the enteric and the CNS, gastrointestinal dysfunction may increase the risk of epilepsy. Meanwhile, about 2.5% of patients with epilepsy were misdiagnosed as having gastrointestinal disorders, especially in children below the age of one year. Gut dysbiosis also has a significant role in epileptogenesis. Epilepsy, in turn, affects the gastrointestinal tract in different forms, such as abdominal aura, epilepsy with abdominal pain, and the adverse effects of medications on the gut and the gut microbiota. Epilepsy with abdominal pain, a type of temporal lobe epilepsy, is an uncommon cause of abdominal pain. Epilepsy also can present with postictal states with gastrointestinal manifestations such as postictal hypersalivation, hyperphagia, or compulsive water drinking. At the same time, antiseizure medications have many gastrointestinal side effects. On the other hand, some antiseizure medications may improve some gastrointestinal diseases. Many gut manipulations were used successfully to manage epilepsy. Prebiotics, probiotics, synbiotics, postbiotics, a ketogenic diet, fecal microbiota transplantation, and vagus nerve stimulation were used successfully to treat some patients with epilepsy. Other manipulations, such as omental transposition, still need more studies. This narrative review will discuss the different ways the gut and epilepsy affect each other.

EPIPLOIC APPENDAGITIS: AN UNCOMMON CASE OF ACUTE ABDOMINAL PAIN WITH CHARACTERISTIC IMAGING FINDINGS.

Introduction: th th Epiploic appendagitis is an uncommon cause of abdominal pain and is frequently undiagnosed. Obese men in their 4 and 5 decade of life are most affected. It generally mimics other serious causes of acute abdomen and thus the denitive diagnosis relies on cross-sectional imaging primarily computed tomography ndings. Most often the condition is caused due to torsion of an epiploic appendage or spontaneous venous thrombosis of a draining appendageal vein. Appendices epiploicae are small (0.5-5 cm long), fat lled pouches of peritoneum projecting from the external surface of colon and are supplied by blood vessels that protrude through the bowel wall. They are present commonly over distal colon particularly numerous at the rectosigmoid junction. Case: We are reporting a case of 42 years old male patient, who presented to the surgical OPD at Dr. RPGMC Tanda with chief complaint of acute abdominal pain localized in the left iliac fossa with tenderness in the region. The ultrasonography report was inconclusive and the patient was further evaluated using biochemical investigations and contrast enhanced CT of the abdominopelvic region. The CECT revealed fat dense ovoid shaped lesion in the left iliac fossa with surrounding fat stranding and hyperdense rim suggestive of intraperitoneal focal fat infarction. The condition was managed conservatively with empirical antibiotics and analgesics. Conclusion: Epiploic appendagitis is a self-limiting disease but persistence of symptoms or recurrence requires surgical management with laparoscopic appendage excision. The anatomical and surgical knowledge of epiploic appendagitis is very important to raise awareness about this clinical condition and to manage it appropriately.

Omental torsion: An uncommon cause of abdominal pain

Introduction: Omental torsion is an uncommon disease that presents with acute abdominal pain. Detailed medical history and physical examination can be sufficient for the diagnosis, although imaging techniques may verify. Case Report: A 55-year-old woman p

Sigmoid volvulus in a child with Autism Spectrum Disorder

Sigmoid volvulus is an uncommon cause of abdominal pain and obstruction in the pediatric population, with most physicians not considering it in the differential diagnosis. History of Autism Spectrum Disorder (ASD) with concomitant volvulus of the sigmoid colon is a rare occurrence that presents with communication challenges that can impair diagnosis and treatment. This is the case of a 10-year-old male patient with ASD who presented with abdominal pain, obstipation, and vomiting. Plain abdominal radiograph showed an intestinal obstructive pattern subjective for sigmoid volvulus. The patient was successfully decompressed with a nasogastric and rectal tube and underwent an open sigmoidectomy with end-to-end coloproctostomy during the same admission. Communication impairment made it difficult to assess subjective parameters such as pain, and nausea. On post-operative day #8 extensive pneumoperitoneum was observed on a chest radiograph and the patient was taken for emergency laparotomy that resulted in a partial colectomy with end colostomy. Sigmoid volvulus is an exceptionally rare occurrence in the pediatric population. High suspicion should be kept for prompt diagnosis and treatment in patients with ASD. Particular attention to objective information such as physical examination, vital signs, laboratories, and imaging studies should be maintained since communication is usually impaired.

Renal infarction as an uncommon cause of abdominal pain. A case report

Renal infarction is a rare cause of abdominal pain whose diagnosis is often misunderstood or severely delayed. The difficulty in identifying this time-dependent condition greatly limits the possibilities of therapeutic intervention and determines the loss of renal parenchyma that could have been saved with prompt diagnosis. It is, therefore, essential to include renal infarction in the differential diagnosis in case of abdominal pain and to identify this pathology beforehand. We present a case of a 65-yearold male with atrial fibrillation in therapy with Edoxaban who was admitted to the hospital for acute onset of widespread abdominal pain with nausea, vomit, and a worsening of renal function according to the laboratory tests. An abdominal computed tomography with contrast confirmed the presence of a bilateral renal infarction. The patient developed chronic kidney disease and was discharged on anticoagulant therapy. The aim of this paper is, therefore, to increase physician awareness towards this condition, the best opportunity to diagnose early renal infarction and to establish acute and long-term therapy.

It is not Appendicitis! It is Appendicitis Epiploica, the Great Pretender

Appendicitis epiploica or epiploicae appendagitis, an uncommon cause of abdominal pain, is usually per-operatively diagnosed. The pedunculated fat-filled small pouches or appendices epiploicae on the serosal surface of the colon often become twisted and sometimes spontaneous thrombosis occurs. Such events lead to ischemia and inflammation at the base of the fatty lobes i.e., Appendicitis epiploicae. Symptoms include sharp localized pain in either iliac fossae and in some cases there is elevated temperature and white blood cell count. In a quarter of the patients there is rebound tenderness and very rarely nausea and vomiting, diarrhoea or constipation. This condition is more common among middle aged males and given its non-specific symptoms. It is usually confused with other more common conditions such as Meckel’s diverticulitis and appendicitis. Less than 8% of patients suspected of having appendicitis or diverticulitis are found to actually have appendicitis epiploicae. Here we report two extremely rare cases of appendicitis epiploica in Bangladesh.
 Journal of Surgical Sciences (2019) Vol. 23(2): 95-97

1661 Colo-Colic Intussusception Secondary to a Large Submucosal Colonic Lipoma

INTRODUCTION: Intussusception is telescoping of a proximal segment of bowel into the lumen of the adjacent distal segment of bowel. This condition is usually seen in the pediatric population and is most often due to a benign pathologic lead point. Intussusception remains a rare condition in adults, representing approximately 1–5% of mechanical bowel obstructions typically due to malignancy. We present a rare case of Colo-colic intussusception secondary to a sub-mucosal benign lipoma. CASE DESCRIPTION/METHODS: A 33-year-old Caucasian woman with no past medical or surgical history, presented with one month of intermittent left-sided and mid-abdominal cramping, which intensified the week prior to presentation. She reported increasing post-prandial pain with associated nausea and bloating. Physical exam revealed stable hemodynamics, and diffuse abdominal tenderness to palpation. Laboratory testing was unremarkable, including a serum pregnancy test. Contrasted CT Abdomen/Pelvis revealed intussusception of the mesenteric tissues and transverse colon into the descending colon with a discrete mass lesion as the lead point (Figure 1). A colonoscopy revealed a large, non-obstructing, hard, negative pillow sign, subepithelial mass, with a short stalk at the hepatic flexure was encountered (Figure 2). The patient underwent laparotomy by colorectal surgeon. A proximal transverse colon intussusception was identified and a right hemicolectomy with ileocolonic anastomosis was completed. Surgical pathology results revealed a 6.5 cm submucosal lipoma without evidence of dysplasia or malignancy (Figure 3). The patient recovered well post-operatively and was discharged. DISCUSSION: In adults, the diagnosis of intussusception can be difficult to make based on clinical presentation alone due to the rarity and non-specific complaints. The condition is commonly related to malignancy. Generally, colo-colic intussusceptions are the least common. Cross sectional imaging, such as CT scans with IV contrast are the most sensitive diagnostic tests. Our case identifies an uncommon cause of abdominal pain in an adult patient with the CT scan and diagnostic laparotomy revealing a colo-colic intussusception. In this fortunate case, pathology revealed a benign lesion as the lead point. Although colonic lipomas are common this patient has low risk factors such as age and no metabolic syndrome, they are often asymptomatic and have been rarely reported to cause similar presentations as they increase in size ( >4 cm).

Segmental arterial mediolysis in splanchnic arteries: an uncommon cause of abdominal pain

Segmental arterial mediolysis is an uncommon arterial disease that primarily involves splanchnic arteries; abdominal pain is the most common clinical manifestation. We report the case of a 53-year-old male with postprandial diffuse abdominal pain of one month's standing. Physical examination was uneventful, and laboratory tests revealed no abnormal findings. Abdominopelvic CT/Angio-CT showed an increased caliber of the superior mesenteric artery resulting from eccentric circumferential wall thickening. The patent lumen had a segment with fusiform aneurysmal dilatation, 7 x 26 mm long. These vascular changes extended along a number of distal jejunal branches, which also presented complete lumen obliteration. Abdominal arteries were free from signs of arteriosclerotic disease. Findings were consistent with segmental arterial mediolysis.

Pedunculated small bowel lipoma with heterotopic pancreas causing intussusception.

Key Clinical MessageSmall bowel intussusception is a relatively uncommon cause of abdominal pain. The diagnosis is often delayed due to vague symptoms and limitations with current endoscopic and radiographic approaches to evaluate the small bowel lumen. Treatment often requires surgical resection, which can usually be performed in a minimally invasive fashion.

Acute idiopathic omental infarction as an unusual cause of left iliac fossa pain: a case report

Acute idiopathic omental infarction is an uncommon cause of abdominal pain. Only about 300 cases have been reported in the medical literature so far.15% of cases occur in the pediatric age group. Omental infarctions are common on the right side and present as right iliac fossa pain. Clinical presentation usually mimics acute appendicitis and leads to unnecessary surgical intervention in majority of the cases. Acute idiopathic omental infarction presenting as left iliac fossa pain has not been reported till now in medical literature. Controversy exist regarding the management of acute omental infarction. While a few authors recommend surgical resection of the infarcted omentum, most authors recommend conservative management. Here we report a case 36 years old lady with acute idiopathic omental infarction presenting as the left sided abdominal pain. Diagnosis was made on contrast enhanced CT imaging. She was managed conservatively with NSAIDs and antibiotics. She was discharged after 2 days of in hospital. She improved clinically on outpatient follow up at 1 week, 1 month and 6 months. In short, acute idiopathic omental infarction is an unusual cause of left iliac fossa pain. Patients may benefit from conservative management, once the diagnosis is confirmed based on imaging. Further studies are necessary to devise a correct guideline on surgical intervention and conservative management in omental infarction.

Percutaneous artery embolization of bleeding rectus sheath hematomas in hemodynamically unstable patients: Outcomes of 43 patients in a tertiary referral hospital

Rectus sheath hematoma (RSH) is an uncommon cause of abdominal pain that can lead to life-threatening bleeding, particularly in elderly patients receiving anticoagulation therapy. Type III RSHs, based on computer tomography (CT) evaluation, is characterized by active bleeding with intramuscular or intraperitoneal extension and hemodynamic instability. Medical contemporary knowledge of this condition is contentious and overall 20% of acute mortality has been reported. The purpose of this study was to retrospectively review our experience and outcomes in the management of RSHs treated with percutaneous arterial embolization of the epigastric vessels. We retrospectively analyzed 43 patients with RSH type III, submitted to percutaneous epigastric artery embolization from 2007 to 2015. Percutaneous arterial embolization was feasible and successful in patients with a high burden of comorbidities and receiving anticoagulation therapy. There was no acute mortality and a late mortality at 3 months of 9.1% (4/43) was not directly related to RSHs or arterial embolization. Patients with late mortality had lower ejection fraction, prolonged PTT, greater RDW and warfarin in overlapping with low-molecular-weight heparins. Transcatheter arterial embolization of the epigastric vessels was safe, feasible and effective in stopping the bleeding. Despite anti-platelets/anti-coagulation therapy and a high burden of comorbidities, there was no acute mortality related to RSH.

Laparoscopic Retrogastric Median Arcuate Ligament Release

Introduction: Median arcuate ligament syndrome (MALS), originally described in 1963 by Harjola, is defined as compression of the celiac axis by an abnormal median arcuate ligament (MAL), characteristically causing postprandial abdominal pain and weight loss. Patients may also complain of nausea, diarrhea, and food aversion. Here we describe a laparoscopic technique for release of the MAL through a retrogastric or retrograde technique. Materials and Methods: We describe a case of an 18-year-old male with MALS, characterized by abdominal pain, 20 kg weight loss, and food aversion. On work-up, he was found to have a normal barium swallow and esophagogastroduodenoscopy. Nuclear gastric emptying study was normal. Abdominal ultrasonography revealed elevated velocities and CT angiogram showed compression of the celiac axis with velocities greater than 200 cm/s. He was taken to the operating room for release of his MAL through a laparoscopic retrogastric approach. Results: Our patient was taken to the operating room for a retrogastric MAL release. This was performed with five trocars including a liver retractor. The MAL was approached by retracting the stomach anterior. The initial goal is to identify the left gastric, hepatic, or splenic artery and then follow one or all of those branches back to the celiac trunk and aorta where the MAL can be identified and divided. He was admitted after surgery, advanced to regular diet, and discharged home on postoperative day 2. He has returned to clinic on multiple occasions for follow-up. He reported complete resolution of his symptoms, including abdominal pain and food aversion. He has recovered the majority of his weight loss at 3 months. Discussion: Traditionally, MAL is approached through laparotomy through the gastrohepatic ligament, with dissection continued through the fibrous MAL found in proximity to the diaphragmatic crura at the origin of the celiac artery.1 Laparoscopic MAL release is becoming more common and can be approached through the antegrade or retrograde (retrogastric) approach.2 The retrogastric approach has the advantage of a better angle of dissection along the aorta and a better angle to divide the MAL as it arches over the celiac trunk. The observation of the origin of the celiac and its branches with the stomach retracted anteriorly is also excellent using this approach. Conclusion: MALS is an uncommon cause of abdominal pain. Here we describe a novel approach to the release of the MAL by utilizing laparoscopy and approaching the celiac axis from beneath the stomach, providing a unique surgical exposure. No competing financial interests exist. Runtime of video: 4 mins 26 secs This research was presented at the American Pediatric Surgery Association in 2015.

Spontaneous Haematoma of the Anterior Rectus Abdominis Muscle

IntroductionSpontaneous haematoma of the rectus abdominis muscle is an uncommon cause of abdominal pain. It occurs mostly in anticoagulated patients. The objective of this paper is to analyse the onset, diagnosis and treatment in patients under anticoagulant therapy. MethodsA retrospective analysis of a prospectively maintained database of all patients with a diagnosis of spontaneous haematoma of the abdominal rectus muscle between March 2003 and December 2014. ResultsThe study included 34 patients, of whom 28 were women, with an average age of 80 years old. All the patients showed a unilateral infraumbilical haematoma. Twenty-eight patients had received long-term anticoagulant treatment (26 with acenocumarol and 2 low molecular weight heparin); and 6 patients were under anticoagulant prophylaxis with low molecular weight heparin. The diagnosis was performed with ultrasound in 7 cases, computed tomography angiography in 27 patients, and with both methods in 6 cases. The treatment consisted of stopping the anticoagulant drug, correcting haemostasis parameters and blood transfusion when required. Ten patients displayed active bleeding in the computed tomography angiography, and 8 underwent selective arterial embolisation. The evolution was successful in 34 patients, however, 2 patients required surgery and, finally, died due to persistent haemorrhage. ConclusionSpontaneous haematoma of the rectus abdominis muscle is more frequent in elderly women under oral anticoagulant treatment. Non-operative treatment is successful in most cases. Computed tomography angiography is useful to determine which patients could benefit from selective arterial embolisation.

Hematoma espontáneo del músculo recto anterior del abdomen

IntroductionSpontaneous haematoma of the rectus abdominis muscle is an uncommon cause of abdominal pain. It occurs mostly in anticoagulated patients. The objective of this paper is to analyse the onset, diagnosis and treatment in patients under anticoagulant therapy. MethodsA retrospective analysis of a prospectively maintained database of all patients with a diagnosis of spontaneous hematoma of the abdominal rectus muscle between March 2003 and December 2014. ResultsThe study included 34 patients, of whom 28 were women, with an average age of 80 years old. All the patients showed a unilateral infraumbilical haematoma. Twenty- 8 patients had received long-term anticoagulant treatment (26 with acenocumarol and 2 low molecular weight heparin); and 6 patients were under anticoagulant prophylaxis with low molecular weight heparin. The diagnosis was performed with ultrasound in 7 cases, computed tomography angiography in 27 patients, and with both methods in 6 cases. The treatment consisted of stopping the anticoagulant drug, correcting haemostasis parameters and blood transfusion when required. Ten patients displayed active bleeding in the computed tomography angiography, and 8 underwent selective arterial embolization. The evolution was successful in 34 patients, however, 2 patients required surgery and, finally, died due to persistent haemorrhage. ConclusionSpontaneous haematoma of the rectus abdominis muscle is more frequent in elderly women under oral anticoagulant treatment. Non-operative treatment is successful in most cases. Computed tomography angiography is useful to determine which patients could benefit from selective arterial embolization.

An uncommon cause of abdominal pain: Mesenteric cyst.

Mesenteric cysts are benign cystic lesions. Here, we present the case of a patient with abdominal pain, which was diagnosed as mesenteric cyst. A 28-year-old male patient was admitted to the emergency department (ED) with abdominal pain and distention. Abdominal palpation revealed a smooth-surfaced mass palpable in the left upper quadrant. Ultrasonography depicted a hypoechoic heterogeneous mass-like structure with a size of 15 × 12 cm. Computerized tomography (CT) showed a well-defined cystic structure with a size of 12 × 12.5 cm near to the duodenum and pancreas. The patient was admitted, and the cystic structure was drained with a percutaneous drainage catheter; then, sclerotherapy was performed using ethyl alcohol with the aid of ultrasonography. The material was sent to the pathology lab and revealed negative results for malignant cell and mucin. The patient underwent a control CT with contrast, which revealed the catheter at the site of the operation and no cystic lesion after procedure. He was discharged 1 week after the procedure. Mesenteric cysts are extremely rare benign lesions of the abdomen, and emergency physicians must consider this disease in the differential diagnosis of abdominal pain. The percutaneous drainage technique performed on our patient is a safe technique for the treatment of selected patients.

An uncommon cause of abdominal pain and weight loss: the superior mesenteric artery syndrome

An uncommon cause of abdominal pain and weight loss: the superior mesenteric artery syndrome

Midgut volvulus as a complication of intestinal malrotation in a term pregnancy.

Intestinal malrotation is an uncommon cause of abdominal pain and normally presents during infancy. Approximately 90% of patients with malrotation are diagnosed within the first year of life, 80% of whom are diagnosed within the first month of life [1]. Intestinal malrotation complicated by midgut volvulus, a well recognized disease entity in infants and children, is rare in adults [2]. We report a pregnant woman with rare small and large bowel infarctions due to intestinal malrotation complicated by midgut volvulus whose signs and symptoms were misunderstood as labor. A 22-year-old primigravida at 38 weeks and 2 days gestation who had been followed during pregnancy at a private obstetric clinic visited our emergency room with the chief complaint of labor pain that had developed 1 h and 30 min previously. On admission, her vital signs were blood pressure 130/90 mmHg and heart rate 83 beats/min, however, the patient suddenly developed hypotension (80/50 mmHg) and tachycardia (134 beats/min) 7 h later, and the fetal heart rate trace decreased from 120-130 to 90-100 beats/min. An emergency Cesarean section was performed and a male newborn (2,870 g) was delivered with an Apgar score of 1 at 1 min. Emergency resuscitation was initiated, at the same time, a 3.0 mm uncuffed endotracheal tube was intubated by the anesthesiologist. The 5 min Apgar score was 4, and he was transferred to the neonatal intensive care unit by a pediatric physician. The obstetric physician found an ischemic change in the small intestine above the uterus of the mother (Fig. 1A). A general surgeon was called, and upon entering the abdominal cavity, the areas of ischemic change were observed from Treitz's ligament of the small intestine to the proximal transverse colon, but no perforation was detected. A congenital intestinal malrotation and mobile colon were observed, and the ischemic ascending colon was located in the middle of the peritoneal cavity (Fig. 1B). The ischemic portion of the ascending colon was completely gangrenous; thus, a right hemicolectomy was performed. Unfortunately, the mother died 2 days after surgery. However, the baby had no major medical problems and was discharged 2 weeks after birth. Fig. 1 (A) Small intestine with ischemic change above the uterus. (B) The ischemic intestine due to volvulus from the proximal transverse colon, with the ischemic portion extending toward to Treitz's ligament of the small intestine. The ischemic ascending colon ... In the present case, the mother had a congenital intestinal malrotation of which she was unaware, and the malrotation was complicated by midgut volvulus at full-term pregnancy; thus, the abdominal pain was misunderstood as labor pain. Furthermore, the physical findings associated with a midgut volvulus during pregnancy can be confusing and are not always those of a classic bowel obstruction [3]. Bowel sounds may be normal, and distention may be absent. Furthermore, she unfortunately had no nausea, vomiting, or constipation. The only abnormal finding was an elevated WBC count before she showed unstable vital signs. The duodenum and cecum incompletely rotate and become close in proximity in cases of intestinal malrotation. This malpositioning results in a short stalk of mesentery that easily twists upon itself, resulting in compression of the superior mesenteric artery. This vascular compression results in ischemia of the intestine and necrosis of the intestinal wall in 1-2 h if left untreated [4], and the necrosis can compromise fetal health. Thus, a high level of diagnostic suspicion is needed for an early diagnosis in such a case. Anesthesiologists should be aware of these conditions and similar cases to rapidly and definitively control vital signs, replace volume, and correct an electrolyte imbalance during anesthesia and to prepare for resuscitation of the neonate if needed. Knowledge of the management of this condition by anesthesiologists may decrease morbidity and mortality of the mother and neonate.