Caecal volvulus in a twin pregnancy: dilemma of a delayed diagnosis

Abstract

Intestinal obstruction during pregnancy is rare. I present a case in which a woman of 37 years 18 th weeks of twin gestation presented with 4 days intermittent abdominal pain with constipation. She was initially admitted for pain relief and treatment for her constipation and nausea. The patient was reviewed and discharged as she felt her symptoms had improved after passing flatus. She was readmitted a day later with severe cramping abdominal pains, feeling unwell, vomiting, sweaty and unable to pass flatus. The patient's symptoms worsened, and eventually she was diagnosed as caecal volvulus and laparotomy was done. A right hemicolectomy with primary anastomosis was performed. Her ongoing antenatal care was unremarkable. She had a vaginal delivery for the 1 st twin, followed by an emergency caesarean section for the 2 nd twin due to a transverse lie with a cord prolapse.