Madam, I appreciate the valuable comments on the case report made by Dr. Rafi. Following are the possible answers to his queries.
Ogilvie syndrome, or acute colonic pseudo-obstruction (ACPO), is a clinical disorder with the signs, symptoms, and radiographic appearance of an acute large bowel obstruction but with no evidence of distal colonic obstruction.¹ Our patient did not give any history of previous abdominal or pelvic surgeries. So, adhesions leading to bowel obstruction were an unlikely event in this case. Furthermore, the absence of any adhesions was confirmed on exploratory laparotomy.
It has been suggested that advance pregnancy can lead to position changes of the caecum with torsion of the superior mesenteric vessels and mesentery of the small bowel. This can simulate bowel obstruction clinically.^2-4 In this case, on preoperative abdominal X ray and on exploratory laparotomy, caecum was found in its normal position. At the same time the whole small bowel was healthy and viable decreasing the possibility of presence of torsion of small bowel mesentery or superior mesenteric vessel compromise and thus, gestational mechanical bowel obstruction. Our patient despite conservative management continued to deteriorate. This is contrary to what is expected with gestational bowel obstruction where patient improves with time.

Abu Bakar Hafeez Bhatti
Department of Surgery, Civil Hospital Karachi.

1.Ogilvie WH. Large intestine colic due to sympathetic deprivation: a new clinical syndrome. BMJ 1948; 2: 671.
2.Ventura-Braswell AM, Satin AJ, Higby K. Delayed diagnosis of bowel infarction secondary to maternal midgut volvulus at term. Obstet Gynecol 1998; 91: 808-10.
3.Anifowoshe SO, Al Hakeem M, Noureldin OH. Case report: Sigmoid volvulus complicating advanced pregnancy. Saudi J Obstet & Gynecol 2005; 5: 89-92.
4.Kantor HM. Midgut volvulus in pregnancy. J Reproduct Med 1990; 35: 577-80.