Diagnosis of a sigmoid volvulus in pregnancy: ultrasonography and magnetic resonance imaging findings

Abstract

Sigmoid volvulus complicating pregnancy is a rare, non-obstetric cause of abdominal pain that requires prompt surgical intervention (decompression) to avoid intestinal ischemia and perforation. We report the case of a 31-week pregnant woman with abdominal pain and subsequent development of constipation. Preoperative diagnosis was achieved using magnetic resonance imaging and ultrasonography: the large bowel distension and a typical whirl sign - near a sigmoid colon transition point - suggested the diagnosis of sigmoid volvulus. The decision to refer the patient for emergency laparotomy was adopted without any ionizing radiation exposure, and the pre-operative diagnosis was confirmed after surgery. Imaging features of sigmoid volvulus and differential diagnosis from other non-obstetric abdominal emergencies in pregnancy are discussed in our report, with special emphasis on the diagnostic capabilities of ultrasonography and magnetic resonance imaging.

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

“…Pregnancy itself predisposes to sigmoid volvulus as enlarging uterus displaces an abnormally mobile sigmoid loop out of the pelvis causing it to twist around the sigmoid mesocolon leading to vascular compromise and obstruction. This could also be a possible explanation of higher frequency of sigmoid volvulus in third trimester of pregnancy [1,2,[4][5][6]8]. Among the reported cases of sigmoid volvulus in pregnancy, most of the patients are in the age group of 15-35 years with 75% of the cases being multiparous and 66% cases occurring in third trimester [3].…”

“…In India and Africa, a high-fiber diet predisposes to sigmoid volvulus while in South America, Chagas disease is a predisposing factor [4,9]. A long redundant sigmoid colon with a narrow mesentery, also known as dolichosigmoid, predisposes to volvulus formation [8]. Pregnancy itself predisposes to sigmoid volvulus as enlarging uterus displaces an abnormally mobile sigmoid loop out of the pelvis causing it to twist around the sigmoid mesocolon leading to vascular compromise and obstruction.…”

“…Additionally, nausea and vomiting could also be the presenting complaints [1][2][3][4][5][6][7][8][9]. On examination, abdominal tenderness, hyperkinetic or absent/hypokinetic bowel sounds and empty rectum are the usual signs [3].…”

“…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.…”

Volvulus of Sigmoid Colon During Full Term Pregnancy with Rectovaginal Fistula: A Case Report

“…A detailed ultrasound examination usually confirms the presence of free fluids in the abdominal cavity, and viability of the fetus. Magnetic resonance imaging is also proposed to be effective tool [3]. Reluctance to obtain radiological evaluation in pregnancy may contribute to diagnostic delay.…”