Sigmoid volvulus complicating pregnancy

Abstract

Sigmoid volvulus complicating pregnancy is an extremely rare complication with fewer than 76 cases reported in literature. We report a case of sigmoid volvulus complicating pregnancy. The sigmoid colon was resected and Hartman's colostomy was performed. The patient had a successful recovery. Aggressive resuscitation followed by early surgical intervention should be undertaken to reduce maternal and fetal morbidity and mortality.

Sigmoid Volvulus Complicating Pregnancy: A Case Report

“…Affected women are generally 15 to 35 years of age, nearly 75% of them are multiparous, and approximately 66% are in the third trimester [1,2,4,5].…”

“…Typical symptoms of SV in pregnancy are intermittent and severe abdominal pain, distention, and obstipation, which are known as SV triad, and additionally nausea and vomiting, while the common signs are abdominal tenderness, distention, hyperkinetic or hypo/akinetic bowel sounds, and empty rectum [1,2,4,6]. Although abdominal pain, nausea, and vomiting, which are the physiologic findings of pregnancy, are generally thought to cloud the clinical picture [1,6], in our experience, abdominal pain in SV is severe, and nausea and vomiting are not prominent symptoms in the second and third trimesters of pregnancy.…”

“…Laboratory findings are not pathogonomic, X-ray is generally avoided, and ultrasonography is helpful providing information about foetus [1,3]. The treatment requires a multidisciplinary approach, and surgical intervention is frequently needed [1,4]. The prognosis of SV is relatively poor [1].…”

Postcesarean Colonic Obstruction due to Sigmoid Volvulus

“…Conservative decompression via rectum will be unsuccessful because of impediment by postpartum bulky uterus to detorsion. 2 Without prompt detorsion, vascular compromise…”

“…Less than 15 cases of colonic volvulus following cesarean 1 and only 76 cases of sigmoid volvulus complicating pregnancy have been reported. 2,3 The presenting features of this complication are mistaken for usual postoperative signs and symptoms causing delayed diagnosis. 4 Therefore, high index of suspicion and prompt surgical interventions are required to minimize maternal morbidity and mortality (around 20%).…”