On a Sunday afternoon in July 2022, an ambulance rushed into the Department of Emergency. Ms. Xu, 26-year-old, was carted out of the ambulance, with severe septic shock, high fever, dyspnea and confusion. She was 12 weeks pregnant, which had made the situation more dangerous. The mortality rate of intestinal volvulus during pregnancy for the mother ranges from 6% to 16.6%, and for the fetus, it is as high as 26% to 44.40%. The multidisciplinary team of PUMCH soon jumped into action and waged an around-the-clock war to save the mother and baby.
The moment Ms. Xu was wheeled into the Department of Emergency, the nurse found that her heart rate had reached 167 beats per minute and her respiration was 50 breaths per minute, but her blood pressure was only 92/77 mmHg. Mr. Xu was immediately taken to the resuscitation room
Ms. Xu’s medical history showed that she suffered from congenital choledochal cyst and had received choledochal-jejunal anastomosis in another hospital six years ago. Two weeks ago, she started to have epigastric pain and frequent vomiting, which was considered as intestinal obstruction. During the course of conservative treatment in another hospital, Ms. Xu had persistent abdominal pain, and ultrasound revealed distension of the small intestinal. The day before she was admitted into PUMCH, her condition had suddenly worsened with significant distension and tenderness in the upper abdomen. It was considered that her intestinal obstruction had aggravated, and she was referred to PUMCH.
Given the severe condition of Ms. Xu, the Department of Emergency immediately launchedthe emergency green passage for pregnancy and childbirth, actively adopted anti-shock treatment, and reported to the Department of Medical Affairs and the General On-duty Office without delay. After being called, Wang Xianze，attending physician of the Department of General Surgery immediately informed Liu Qiaofei, the deputy director who was the second line of duty. After bedside consultation, he reported the patient’s condition to professor Lin Guole, deputy director professor Wang Weibin and director professor Zhang Taiping. Three professors rushed to the hospital from home. They joined the consultation, guided the resuscitation, and determined the key points for the next-step treatment.
At 17:00, Ms. Xu’s urgent laboratory results came out. CT suggested massive intestinal distention in the upper abdomen with massive ascites, which indicated closed-loop small intestinal obstruction caused by small intestinal volvulus. The CBC count of peripheral blood showed that the number of white blood cells was 44.3*109/L and the neutrophil level was 92.3%, suggesting that she was in severe septic shock. After multi-disciplinary consultation, the patient was diagnosed with bowel necrosis, and surgery was strongly recommended.
At 18:00, the patient entered the operating room after a full preoperative preparation. Zhang Taiping was the surgeon, Lin Guole and Liu Qiaofei were the first and second assistant respectively. During the operation, it was found that the patient's jejunal anastomosis had twisted, and the small intestinal had been congested and swollen like a balloon, leading to severe infection and partial necrosis. The team resected the necrotic intestine and reconstructed the anastomosis. During the whole procedure, the team performed very gently to ensure that Ms. Xu's vital signs were stable and minimize the influence on the fetus.
Although rare, intestinal volvulus during pregnancy may endanger the life of the mother as well as the fetus, because of the rapid development of the intestine necroses after ischemia. After surgery, Ms. Xu gradually recovered under the care of the multidisciplinary team, and the fetus showed no abnormalities. During her stay in PUMCH, the multidisciplinary team carried out additional joint consultations and formulated a follow-up plan for recovery at home and pregnancy management. "I can’t imagine what would have happened without PUMCH!" Ms. Xu said with gratitude.
Reporter: Gan Dingzhu
Correspondent: Liu Qiaofei
Translator: Liu Haiyan
Editor: Hou Rui and Wang Yao