Sigmoid Volvulus in Pregnancy Assessed by Contrast-Enhanced Computed Tomography Scanning

Abstract

Sigmoid volvulus requires urgent treatment, and it is particularly rare among pregnant women without a history of laparotomy. A delay in diagnosis may lead to serious consequences for the mother and fetus, and a rapid diagnosis and treatment in this setting is essential. The patient was a 19-year-old primiparous woman. She complained of repeated exacerbations and remissions of abrupt lower abdominal pain for the past 2 days and was transported to our hospital at 33 weeks of gestation. Ultrasonography revealed no placental thickening, and maternal bowel dilation was difficult to identify. Plain abdominal X-ray showed a dilated colon on the left side of the abdomen. Contrast-enhanced CT scan of the abdomen revealed a volvulus on the dorsal side of the uterus. The proximal end of the transverse to sigmoid colon was markedly dilated, and the distal end was collapsed. The elevated lactate level on blood gas analysis suggested intestinal ischemia. She was suspected of having a sigmoid volvulus at 33 weeks and 3 days of gestation. We decided to perform a cesarean section to secure the operative field for an intestinal resection following delivery. A male weighing 1840 g with Apgar scores 8/8 was delivered. The sigmoid colon was approximately 80 cm in length. A 360-degree clockwise rotation of was observed with a very distended but viable sigmoid loop. Following reduction of the volvulus, the sigmoid colon was fixed to the left side of the peritoneum. The mother had an uneventful postoperative course, and the infant was discharged without any sequelae. This case demonstrates two important lessons. First, sigmoid volvulus can occur in pregnant women even if they never had a laparotomy. Second, abdominal contrast-enhanced CT is useful for rapid diagnostic and treatment decisions relative to this pathology.

Management of sigmoid volvulus during labor : a challenging situation

“…The reported incidence varies widely (from 1 in 66,431 to 1 in 1,500 deliveries) 1 . To date, only 120 cases have been reported 2 . It is challenging to diagnose it which causes a delay in treatment.…”

“…The mortality rates are high and directly correlated with the degree of necrosis. It is estimated at 5% with viable colon and climbs to 50% when perforation occurs 2 . There are multiple management options: operative and non-operative, and the choice depends on many maternal-fetal factors.…”

Response: Sigmoid volvulus in pregnancy: A rare case report

“…of that SV is even rarer. 5 Adhesions and scar tissues from previous abdominal surgery besides chronic constipation, prolonged use of laxatives, neuroleptic drugs, and chagas disease (megacolon) increase the risk of sigmoid volvulus. 6 Pregnancy itself can increases the risk of SV and are no known tactics to prevent the recurrence other than sigmoid colectomy.…”

“…8 Additionally, the possible risk of teratogenesis with CT scan radiation dose is marginal during the third trimester. 5,9 Magnetic resonance imaging (MRI) and other modalities can also be used, however their availability in emergent situations is not reliable, and the associated increased cost could be an issue as well, for some patients.…”

Letter to the Editor: Management of sigmoid volvulus during labor: a challenging situation

“…In this way, we would like to share our ideas on SV associated with pregnancy or delivery. First, pregnancy complicating SV is a fairly seldom clinical entity worldwide with little more than 110 cases reported to date 3 . Similarly, labour together with SV is extremely rare, the number of which can be counted on the fingers of one hand 4 .…”