Caecal Volvulus in Pregnancy: Is Delay in Diagnosis Avoidable?

Abstract

Intestinal volvulus is not an uncommon cause of obstruction in pregnancy. Diagnosis is often delayed due to poor knowledge of the condition and a hesitation to use abdominal X-rays in a pregnant patient. Here, two cases of caecal volvulus in pregnancy are reported. Proper diagnosis and early treatment of the condition is emphasized.

Coecal volvulus: An acute complication of pregnancy

“…[2] The incidence of coecal volvulus increases with the duration of gestation and is greatest at times of rapid uterine size changes, especially from 16 to 20 weeks, when the uterus becomes an intra-abdominal organ; from 32 to 36 weeks, as the fetus enters the pelvis; and in the puerperium, when the uterine size changes rapidly again. [34] In our case, the patient was at the 26 th week and cannot be included in these patients.…”

Cecal volvulus after twin gestation: laparoscopic approach

“…The operative treatment of nongangrenous cecal volvulus is controversial. Right hemicolectomy, cecopexy, tube cecostomy, and simple detorsion may be used [6,10]. In our case, there were no intraoperative signs of ischemia or gangrene of the cecum.…”

“…The high incidence of colonic volvulus during pregnancy is related to uterus enlargement. Specifically, it usually happens between 16 and 20 weeks of gestation, when the uterus comes out into the peritoneal cavity, then between 32 and 36 weeks of gestation, due to forceful uterine compression in the pelvis, and finally immediately after delivery [6]. Delivery leads to rapid reduction in intraabdominal contents, which affect intestinal mechanical balance and stability leading to bowel volvulus [7].…”

“…Cecal volvulus is in fact an axial twisting or folding of the bowel on its mesentery, which can lead to bowel obstruction [6]. In many cases, ischemia or gangrene of the cecum is also present at the time of diagnosis, increasing maternal and fetal morbidity and mortality, even up to 50% [1].…”

Maternal small-bowel volvulus hindered by prodromal labor

“…Symptoms, including abdominal cramps and vomiting, are usually attributed to the normal discomforts of pregnancy and labor, resulting in delayed diagnosis [4,5]. Here we report a case of ileal volvulus that occurred at term treated with wide bowel resection.…”