Complete small-bowel volvulus complicating the second trimester.

BACKGROUND: Volvulus is the second most common cause of intestinal obstruction in pregnancy. Rarely is the small bowel involved, and even less frequently is the volvulus complete. CASE: The patient was referred at 24 weeks and 4 days' gestation for persistent anorexia, emesis, and abdominal distention. History, physical examination, and abdominal radiographs were consistent with a complete small-bowel obstruction. Laparotomy revealed two adhesive bands, which were lysed, and a 360 degrees volvulus of the small bowel about its mesentery, which was successfully reduced. CONCLUSION: This patient represents a case of complete small-bowel volvulus successfully treated in the second trimester by detorsion.

Effect of the HELLP syndrome on maternal immune function.

The HELLP syndrome occurs in less than 1% of gravidas and is characterized by hemolysis, elevated liver enzymes and low platelet count. The status of immune function in these high-risk patients is not known but may be of great importance in better understanding the basis, if any, of immune dysfunction in pregnancy-associated hypertensive disorders and from the potential compounding effect of infection upon an already debilitated patient. We assessed maternal immune status in patients with the HELLP syndrome using conventional in vitro techniques. The results of these studies clearly show a depression of both T and B cell potential and impaired monocyte handling of intracellular pathogens (up to 33%, 11% and 17% of control values, respectively). The onset of this immunosuppression occurred before the clinical diagnosis of HELLP syndrome was made and persisted for at least 14 days after clinical resolution. Results of cell admixture studies suggest that these effects are mediated by accessory cells or their products and do not represent true lymphocyte dysfunction. The risk of opportunistic infections may therefore be increased in the patient with the HELLP syndrome because of this generalized immunosuppression and profound decrease in monocyte phagocytic and bactericidal activity.