Colonic obstruction due to sigmoid colon volvulus during pregnancy is a rare but complication with significant maternal and fetal mortality. We describe a case of sigmoid volvulus in a patient with 33 weeks of gestation that developed complete necrosis of the left colon.Case. 27-year-old woman was admitted with 3 days of abdominal distention, vomit, and the stoppage of the passage of gases and feces. She was admitted with poor clinical conditions with septic shock, acute respiratory distress syndrome, and signs of diffuse peritonitis. Abdominal radiography showed severe dilation of the colon with horseshoe signal suggesting a sigmoid volvulus, pneumoperitoneum and we could not we could not identify fetal heartbeats. With a diagnosis of complicate sigmoid volvulus she was underwent to the laparotomy where we found necrosis of all descending colon due to double twist volvulus of the sigmoid. We performed a colectomy with a confection of a proximal colostomy, and closing of the rectal stump. Due to an uncontrollable uterine bleeding during cesarean due, it was required a hysterectomy. The patient had an uneventful postoperative course thereafter and was discharged on a regular diet on the 15th postoperative day.

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IntroductionAs a result of the coronavirus disease 2019 (COVID-19) pandemic the year 2020 brought major changes on the delivery of health care and face to face physician patient communication was significantly reduced and the practice of remote telehealth care using computer technology is assuming a standard of care, particularly, with COVID-19 patients with attempts to reduce viral spread.ObjectiveTo describe the clinical practice experience using telemedicine towards COVID-19 and the respective clinical outcomes.MethodsWe performed a pilot open-label non-randomized, controlled clinical trial. The patients were divided into four groups, according severity of symptoms: (1) asymptomatic, (2) mild symptoms, (3) moderate symptoms and (4) severe symptoms, and were followed up for five days, counted from the beginning of the symptoms. A drug intervention was performed in group 3, for which the protocol followed as suggested by the International Pulmonology Society’s consensus for adults with moderate symptoms: first day (attack phase) hydroxychloroquine sulfate 400 mg 12/12h; second to fifth day (maintenance phase) 200 mg (half pill) 12/12h. The medication was associated with azithromycin 500mg once a day for five days. For children with moderate symptoms were used: hydroxychloroquine sulfate 6.5 mg/kg/dose every 12 hours in the first day and 3.25 mg/kg/dose every 12 hours from day 2 to 5. The therapeutic response was telemonitored. Group 4 patients were directly oriented to seek hospital care. During the use of the drugs, the patients were telemonitored daily.ResultsOne hundred eighty-seven patients were seen with mean age of 37,6 years (±15,6). The most frequent symptom was cough (57,6%), followed by malaise (60,3%), fever (41,1%), headache (56,0%), muscle pain (51,1%). Of all the patients that sought telemedicine service in our center, 23% were asymptomatic despite contact with people with probable diagnostic of COVID-19; 29,4% reported mild symptoms, 43,9% moderate symptoms, and 3,7% severe symptoms. It was possible to observe in patients treated their symptoms of COVID-19 (group 3) with hydroxychloroquine and azithromycin for five days, presented statistically better improvement of the symptoms when compared to those that did not follow the protocol (p = 0.039). Three patients were hospitalized and discharged after recovery.ConclusionsOur study showed that patients with COVID-19 who had delivery of health care through telemedicine initiated in early stages of the disease presented satisfactory clinical response, reducing the need of face-to-face consultations and hospitalizations. Our results indicate that the use of telemedicine with diagnosis and drug treatment protocols is a safe and effective strategy to reduce overload of health services and the exposure of healthcare providers and the general population to infected patients in a pandemic situation.Trial registrationRBR-658khmHuman Research Ethics Committee number: 30246520.0.0000.0069