A Rare Case of Bowel Gangrene in Pregnancy : A Surgical and Obstetric Catastrophe.

ABSTRACT

An unusual case of bowel gangrene involving jejunum upto the middescending colon leading to septicaemic shock, presented as a case of placental abruption with IUD with shock. Case Report The 25 year old primigravida patient with 34 weeks of gestation was referred from peripheral obstetrician to SVNGMC, in a state of shock with clinical features suggestive of concealed type of placental abruption with IUD. In view of placental abruption with shock, emergency caesarean section was performed. Per Operative Findings: Foul smelling peritoneal fluid, IUD. Baby with placental separation with RP clot and gangrenous bowel from jejunum to middescending colon. As such long segment of bowel was involved; surgeon decided resection and end to end anastomosis was not possible. Propable diagnosis like superior mesenteric artery thrombosis/ Embolism was made. pt was put on low dose inj. Heparin and later managed in Surgical I.C.U. & succumbed on day 3 postop. Conclusion: Hypercoagulable state normally found in pregnant women which is believed to result in superior mesenteric vessel thrombosis and then intestinal ischaemia. It is extremely important not to miss any complaint like pain in abdomen and other G.I. complaints that may have any surgical or medical pathology associated with pregnancy.