Hindawi Publishing Corporation Case Reports in Obstetrics and Gynecology Volume 2012, Article ID 236109, 3 pages doi:10.1155/2012/236109 Case Report Gangrenous Cecal Volvulus Complicating Puerperium: Is the Delay in Diagnosis Really Inevitable? Chanderdeep Sharma,1 Shashank Shekhar,1 Satish Kumar,2 and Rajesh Chaudhary2 1 Department of Obstetrics & Gynecology, Dr. RPGMC at Tanda, Set No. 112, Vivekanand Resident Hostel, Tanda 176001, India 2 Department of General Surgery, Dr. RPGMC at Tanda, Tanda 176001, India Correspondence should be addressed to Chanderdeep Sharma, cdsharma2005@yahoo.com Received 4 March 2012; Accepted 10 April 2012 Academic Editors: J.-H. Nam and K. Takeuchi Copyright © 2012 Chanderdeep Sharma et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Volvulus in puerperium is a rare event. We present a case of cecal volvulus following normal vaginal delivery that ended with cecal gangrene and hemicolectomy. 1. Introduction Intestinal obstruction is a very rare event during pregnancy with reported incidence varying widely between 1 in 1500 to 1 in 66431 [1]. The most common cause of intestinal obstruction during pregnancy and puerperium is postsurgi- cal adhesions (60–70%) followed by volvulus, which is seen in 25% of cases [1, 2]. Due to a host of reasons peculiar to pregnancy and puerperium diagnosis is often delayed and thus a simple mechanical obstruction of viable gut can become a serious case of volvulus with gangrene and life- threatening complications. We report a case of cecal volvulus during puerperium with delayed diagnosis leading to bowel gangrene to highlight the consequences and to ask a valid question: is the delay in diagnosis during pregnancy and puerperium really inevitable? 2. Case Report A 26-year-old para two was referred to our hospital on third postpartum day with history of sudden onset lower abdominal cramping pain, abdominal distension, vomiting, and obstipation for two days. The patient had a sponta- neous term uncomplicated vaginal delivery at home. The patient was earlier managed at a peripheral health institute conservatively and was referred to our hospital when her condition deteriorated. Her previous delivery was home conducted as well. There was no history of abdominal surgery in the past. Examination revealed moderate pallor and tachycardia. Abdomen was grossly distended and tender. Bowel sounds were absent. Routine investigations revealed hemoglobin of 6.4 gm% and an elevated leucocytic count of 16,000 per cubic mm. Simple abdominal radiograph revealed a hugely distended large bowel segment in the upper quadrant as shown in Figure 1. The general condition of the patient worsened in the next few hours with appearance of signs of peritonism. Leucocytic count soared to 21000 per cubic mm, and decision for immediate laparotomy was taken with a provisional diagnosis of large bowel obstruction. On exploration, there was a grossly distended, gangrenous cecum displaced in the upper left quadrant as shown in Figure 2. The gangrenous gut was resected with ileotrans- verse anastomosis. The patient had uneventful recovery and was discharged on day 15. 3. Discussion Volvulus of the cecum is an axial twisting or folding of cecum on its mesentery that results in bowel obstruction [3]. The incidence of volvulus is the greatest at times of rapid changes in uterine size and can occur during mid pregnancy, third trimester, and more commonly during puerperium [4]. The most common site of volvulus in pregnancy is sigmoid colon followed by small bowel and cecum [4, 5].