Flexible endoscopic decompression for treatment of sigmoid volvulus in pregnancy

Rottenstreich, Misgav; Mosmar, Khaled; Ehrlich, Zvi; Kitroser, Ella; Grisaru‐Granovsky, Sorina

doi:10.1016/j.ejogrb.2019.09.020

Cited by 5 publications

(8 citation statements)

References 4 publications

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“…MRI shows the whirl sign in mesentery with a dilated sigmoid colon in addition to fetus-related material (Figure 2). If endoscopy or MRI are not available, a single abdominal X-ray radiography may be used [7,9,13]. Similarly, if needed, a computed tomography (CT) imaging can be taken as a terminal choice [8,13].…”

Section: Discussionmentioning

confidence: 99%

Sigmoid volvulus in pregnancy: Current approach in diagnosis and treatment

Dişçi¹,

Peksöz²,

KARA³

et al. 2022

Journal of Surgery and Medicine

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Background/Aim: Sigmoid volvulus (SV) is an uncommon disease worldwide, while SV complicating pregnancy is extremely rare. The aim of this study is to evaluate the current diagnostic and therapeutic options in SV during pregnancy in a case series. Methods: The clinical data of 1,046 patients with SV, including 11 pregnant women, were reviewed retrospectively. Age, gestation period, previous history of volvulus, presence of comorbidities, duration of complaints, symptoms, signs, diagnostic tools, treatment procedures and prognosis were noted. Rigid or flexible sigmoidoscopy and magnetic resonance imaging (MRI) were used in the diagnosis, while abdominal X-ray and computerized tomography (CT) were avoided. Stable patients were treated with endoscopic decompression, while emergent surgery was needed in complicated cases with necrosis, peritonitis, or unsuccessful endoscopic decompression. Results: The mean age was 31.0 years (24-39 years). All cases were multiparous. Of the patients, 6 (54.5%) were in third trimester, 4 (36.4%) were in second trimester, and 1 (9.1%) was in first trimester. SV was diagnosed by endoscopy in 6 patients (54.5%), by magnetic resonance imaging (MRI) in 2 (18.2%), and during laparotomy in 3 (27.3%) patients. 6 patients (54.5%) were decompressed by sigmoidoscopy, while 5 cases (45.5%) were treated with surgery. One patient (9.1%) was lost due to toxic shock arising from sigmoid necrosis, while a stillbirth (9.1%) was developed following the surgical procedure in the same case. Conclusion: Although common findings including abdominal pain, obstipation and distention are prominent clinical features of SV, some clinical findings of pregnancy may cloud the pathology during pregnancy. We recommend sigmoidoscopy or MRI in the diagnosis of pregnant patients with suspected SV. Although enlarged uterus is generally thought as an impediment factor for endoscopic decompression, flexible sigmoidoscopy is currently preferred in the treatment of uncomplicated and non-gangrenous patients, while gangrenous or complicated cases are required emergency surgery regardless of the gestation period.

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Section: Discussionmentioning

confidence: 99%

Sigmoid volvulus in pregnancy: Current approach in diagnosis and treatment

Dişçi¹,

Peksöz²,

KARA³

et al. 2022

Journal of Surgery and Medicine

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show abstract

Section: Discussionmentioning

confidence: 99%

“…13 Successful multiple endoscopic interventions during pregnancy have been reported and are becoming the preferred method to relieve obstruction but are still very uncommon since less than 10 cases of recurrent SV in the same pregnancy have been des cribed. 3,4,11,14,15 In the absence of acute perforation or ischemia, definitive operative treatment with elective colon resection with primary anastomosis is recommended after resolution of the acute volvulus phase to prevent recurrence. 5 However, surgery in a gravid uterus can be complex and the time frame until elective surgery is performed is still controversial.…”

Section: Discussionmentioning

confidence: 99%

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Endoscopic Decompression of Recurrent Sigmoid Volvulus in Pregnancy

Cortez

Berzosa

Muddasani

et al. 2020

Journal of Investigative Medicine High Impact Case Reports

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Sigmoid volvulus is a rare condition seen during pregnancy with high maternal and fetal morbidity and mortality. We report a case of a young 26-year-old woman, primipara, in her third trimester who presented with recurrent sigmoid volvulus at both 30 and 32 weeks of gestation. She underwent successful repetitive endoscopic decompression on both admissions with uneventful recovery. Endoscopic evaluation is safe in pregnancy and uncomplicated volvulus. It allows for diagnostic confirmation and assessment of complications; and it has successful outcomes in the presence of a multidisciplinary team.

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“…Reports have described successful decompression of sigmoid volvulus by sigmoidoscopy. 18 The diagnostic value of sigmoidoscopy is highest for hematochezia (76%) compared to other indications (29%). 19 Reported change in management after sigmoidoscopy/colonoscopy ranges from 35 to 78%.…”

Section: Indicationsmentioning

confidence: 98%

Endoscopy in Pregnancy: A Systematic Review

Pal

Reddy

Tandan

2021

Journal of Digestive Endoscopy

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Background Fetomaternal outcomes are of primary concern for gastrointestinal (GI) endoscopy in pregnancy. We aimed to systematically review the safety and utility of endoscopic procedures in pregnancy. Methods A systematic literature search was performed using PubMed. All original research articles with sample size > 10 involving endoscopy in pregnancy were included for the review along with case report/series describing novel/rare techniques from 1948 to July 2021. Results After screening 12,197 references, 216 citations were found and finally 66 references were included. Esophagogastroduodenoscopy had favorable fetal outcome (>95%) based on two large retrospective studies and a review of case reports. Sclerotherapy and band ligation of varices were safe according to case series. A large nationwide cohort study established safety of endotherapy for nonvariceal bleed. Botulinum toxin and pneumatic dilation in achalasia are only supported by case reports. Percutaneous endoscopic gastrostomy can be useful to support nutrition based on case reports. A retrospective case–control and cohort study with systemic review justified flexible sigmoidoscopy if strongly indicated. Low birth weight was more common when sigmoidoscopy was done in inflammatory bowel disease based on a prospective study. Colonoscopy was considered safe in second trimester based on a case–control study whereas it can be performed otherwise only in presence of strong indication like malignancy. Capsule endoscopy is promising and can be useful in acute small bowel bleeding although risk of capsule retention is unknown. There are no reports of enteroscopy in pregnancy. Twelve retrospective studies and one prospective study showed high success rate of therapeutic endoscopic retrograde cholangiopancreatography (ERCP) (> 90%) in all trimesters and can be performed if strongly indicated. Pregnancy was an independent risk factor for post-ERCP pancreatitis in a large nationwide case–control study. Radiation-free ERCP with wire-guided bile observation, stent-guided or precut sphincterotomy, endoscopic ultrasound (EUS) guidance, and spyscopy have been described. Safety of EUS is limited to case series and can be used in intermediate probability of choledocholithiasis to guide ERCP and endoscopic cystogastrostomy. Conclusion This review concludes that GI endoscopy during pregnancy can be done effectively if strongly indicated with good fetomaternal outcomes. Precautions are advocated during procedures where radiation exposure is expected.

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Flexible endoscopic decompression for treatment of sigmoid volvulus in pregnancy

Cited by 5 publications

References 4 publications

Sigmoid volvulus in pregnancy: Current approach in diagnosis and treatment

Sigmoid volvulus in pregnancy: Current approach in diagnosis and treatment

Endoscopic Decompression of Recurrent Sigmoid Volvulus in Pregnancy

Endoscopy in Pregnancy: A Systematic Review

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