Volvulus of the Sigmoid Colon during Pregnancy: A Case Report

Abstract

<jats:p>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.<jats:italic>Case</jats:italic>. 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.</jats:p>

Sigmoid volvulus during second trimester of pregnancy in a primigravida: Report of a rare case with review of imaging of sigmoid volvulus

“…The incidence of intestinal obstruction in pregnancy ranges from 1:1500 to 1:66431 [1][2][3][4]. The differential diagnosis for intestinal obstruction in pregnancy includes congenital or postoperative adhesions, volvulus, hernia, intussusception, malignancy and appendicitis [1,2,4,5].…”

“…The incidence of intestinal obstruction in pregnancy ranges from 1:1500 to 1:66431 [1][2][3][4]. The differential diagnosis for intestinal obstruction in pregnancy includes congenital or postoperative adhesions, volvulus, hernia, intussusception, malignancy and appendicitis [1,2,4,5]. Sigmoid volvulus is the most common cause of intestinal obstruction accounting for 25-44% of the reported cases in literature [1][2][3][4][5][6][7].…”

“…The differential diagnosis for intestinal obstruction in pregnancy includes congenital or postoperative adhesions, volvulus, hernia, intussusception, malignancy and appendicitis [1,2,4,5]. Sigmoid volvulus is the most common cause of intestinal obstruction accounting for 25-44% of the reported cases in literature [1][2][3][4][5][6][7]. It is extremely important to diagnose this condition early as a delay in diagnosis can lead to maternal as well as fetal complications.…”

“…Fetal mortality in sigmoid volvulus is estimated to be approximately 30% [1,6]. The diagnosis of sigmoid volvulus in pregnancy is challenging as the symptoms and signs of intestinal obstruction could be masked by pregnancy itself [1,3,4,6,8]. Another problem faced by the clinicians is regarding the choice of the diagnostic imaging modality.…”

“…Magnetic resonance imaging scan could be used as a problem solving tool in the diagnosis of the cause of intestinal obstruction. It is not only free of radiation hazard but can also provide an accurate preoperative diagnosis of the etiology [3,4]. However, availability of MRI scan in many centers across developing countries is a limiting factor.…”