Volvulus of the Sigmoid Colon during Pregnancy: A Case Report

Endoscopic detorsion of sigmoid volvulus in a young female: a case report

BACKGROUND

A volvulus refers to the torsion or rotational twisting of a portion of the gastrointestinal tract, with a predilection for impacting the caecum and sigmoid colon, often resulting in the development of bowel obstruction. The risk factors associated are old age, chronic fecal impaction, psychiatric disorders, colonic dysmotility, prior abdominal surgical procedures, diabetes, and Hirschsprung's disease. Elderly are most commonly affected with sigmoid volvulus but there are few cases among young adults that culminate in grave complications. Although it is rare, but young individuals presenting with acute abdomen secondary to sigmoid volvulus need urgent attention. To prevent more invasive surgical procedures, endoscopic detorsion is preferred nowadays with complete recovery of patients. We present a case of young female who was successfully managed with endoscopic detorsion.

CASE PRESENTATION

27 years old Asian Pakistani female presented with worsening abdominal distention, constipation and vomiting since 2 days. On examination she was afebrile, vitally stable. Abdomen was distended, tympanic percussion with generalized tenderness. Abdominal radiograph was obtained which showed dilated bowel loops followed by Computed tomography of abdomen which was suggestive of Sigmoid volvulus causing intestinal obstruction. Patient was immediately moved to endoscopy unit and endoscopic detorsion of volvulus was done. For individuals who present with sigmoid volvulus and do not exhibit signs of peritonitis or colonic gangrene, the recommended course of action involves acute endoscopic detorsion, followed by scheduled surgical intervention.

CONCLUSION

This case report emphasizes the significance of clinicians considering sigmoid volvulus as a rare but important cause when evaluating abdominal pain in young and otherwise healthy patients. A delay in diagnosis and treatment extending beyond 48 hours leads to colonic necrosis, amplifying the associated morbidity and mortality. Swift intervention is imperative to mitigate these complications and attain a conclusive remedy.

Successful Vaginal Delivery during Acute Small Bowel Obstruction: A Case Report and Review of the Literature

Small bowel obstruction during pregnancy is rare and can be detrimental to both mother and fetus. In most cases, management eventually involves surgical intervention. Little is known regarding optimal mode of delivery in those with bowel obstruction during pregnancy. We present a case of vaginal delivery during acute small bowel obstruction as well as a review of recent literature regarding mode of delivery in the setting of bowel obstruction. Our case and literature review demonstrates that in pregnancies complicated by small bowel obstruction, successful vaginal delivery can be achieved in those with stable maternal-fetal status.

Intestinal malrotation complicated by an occlusive syndrome involving internal hernia in a pregnant woman

We present the case of a 33-year-old female who presented intestinal obstruction at the 7th month of pregnancy. She was complaining of abdominal pain with paroxysms, nausea and vomiting. When the symptoms worsened, we performed a CT-scan, which revealed suspected intestinal obstruction in a context of intestinal malrotation (IM). Conservative therapy failed and she required emergency laparotomy beginning with a caesarean section. The surgery revealed a peritoneal defect due to the IM through which the jejunum and ileum were incarcerated and strangulated. The incarcerated bowel was reduced and intestinal colour quickly returned to normal. Primary closure of the peritoneal defect was thus performed and the post-operative course was uneventful for the mother and the baby, who was admitted to the neonatal intensive care unit.

Sigmoid volvulus in pregnancy: case report and review of literature

Sigmoid volvulus in pregnancy is a very rare condition. Despite this, clinicians should have a high index of suspicion of this condition if they encounter a pregnant woman with symptoms suggestive of bowel obstruction. Incorrect diagnosis may be catastrophic, resulting in major complications, including fetal and maternal death.

Sigmoid volvulus during pregnancy: A rare non-obstetric complication. Report of a case and review of the literature

INTRODUCTION

Sigmoid volvulus is a rare cause of intestinal obstruction during pregnancy associated with high maternal and foetal mortality. Effective management represents a challenge due to delayed presentation, obstructive symptoms regarded as pregnancy-related and hesitation in using radiological evaluation.

PRESENTATION OF CASE

We report a case of a lady, pregnant for 26 weeks and with a 5 day history of abdominal pain and constipation. She underwent concomitant caesarean section and laparotomy for intestinal obstruction. Intra-operatively, the sigmoid colon was extensively dilated and gangrenous. The ischemic colon was resected and a Hartmann's procedure was performed. A preterm male child was delivered and admitted to neonatal intensive care. The post operative course was uneventful and the patient was discharged home on the 9th post-operative day. Six months later she underwent an uneventful reversal of the Hartmann's procedure.

DISCUSSION

Sigmoid volvulus is the most common cause of bowel obstruction during pregnancy, accounting for up to 44% of reported cases. We have reviewed the available literature on this topic and present another case managed at our institution.

CONCLUSION

Diagnosis of sigmoid volvulus in pregnancy is a challenge, but a delay in diagnosis increases the rates of feto-maternal mortality. A high incidence of clinical suspicion and timely surgical intervention are the key to a favourable outcome.

Endoscopic reduction of a volvulus of the sigmoid colon in pregnancy: case report and a comprehensive review of the literature

Sigmoid volvulus is a rare, but serious, complication that can occur during pregnancy. We present a case of a 33-year-old pregnant female in the third trimester with a sigmoid volvulus. Detorsion of the volvulus was performed during colonoscopy. The patient underwent an elective sigmoidectomy at a later date. Prompt diagnosis of the volvulus sigmoid is critical to minimize fetal and maternal morbidity and mortality. Sigmoidoscopic detorsion or surgical resection are the treatment options, depending on bowel viability. A review of the literature was done.