Sigmoid volvulus in pregnancy and puerperium: a case series

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

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.

Sigmoid Volvulus Complicating Postpartum Period

Background. Sigmoid volvulus is a rare complication of pregnancy and the puerperium. Case. A 19-year-old patient, gravida 1 para 0 at 41 0/7 weeks of gestation, admitted for late-term induction of labor underwent an uncomplicated primary low transverse cesarean delivery for arrest of descent. Her postoperative period was complicated by sudden onset of abdominal pain and the ultimate diagnosis of sigmoid volvulus. Conclusion. Prompt surgical evaluation of an acute abdomen in the postpartum period is essential; delayed diagnosis and treatment can lead to significant maternal morbidity and mortality.

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.

Small bowel volvulus in mid and late pregnancy: can early diagnosis be established to avoid catastrophic outcomes?

Volvulus in pregnancy is rare and difficult to diagnose. Delayed diagnosis would result in high maternal and fetal mortality. Here we present an unusual case of small bowel volvulus in late pregnancy timely managed by emergency Cesarean section and derotation with excellent maternal and fetal outcomes. Volvulus should be considered in patients complaining ongoing abdominal pain, nausea, vomiting, constipation even diarrhea. Imaging is essential for early and precise diagnosis, including plain abdominal film, MRI and/or ultrasound. Once highly suspected or diagnosed of volvulus or ileus, emergency laparotomy should be performed immediately to avoid catastrophic outcomes, because the maternal and fetal prognosis is dependent on the interval from volvulus to operation apart from the degree of volvulus.

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.

Sigmoid volvulus in pregnancy: early diagnosis and intervention are important

Bowel obstruction is rare in pregnancy, and delay in recognition can lead to serious maternal and fetal complications. Most reported causes of bowel obstruction in pregnancy (adhesions, intussusception, hernia, and carcinoma) require surgical intervention. Sigmoid volvulus is an acute surgical cause that can now be managed successfully without surgery. We report the case of 33-year-old lady who presented with a sigmoid volvulus that was successfully managed with urgent endoscopic decompression.

Factors affecting bowel gangrene development in patients with sigmoid volvulus

BACKGROUND AND OBJECTIVES

Sigmoid gangrene develops in 6.1% to 93.4% of sigmoid volvulus (SV) cases, and increases the mortality rate from 0% to 40% without bowel gangrene to 3.7% to 80%. This study aimed to investigate factors that induce bowel gangrene development in SV patients.

DESIGN AND SETTINGS

Retrospective study from a single center.

PATIENTS AND METHODS

We determined whether there was any correlation between sigmoid gangrene and the following factors: age, gender, a previous history of a volvulus, previous history of abdominal surgery, pregnancy, major comorbidities, shock, duration of symptoms, direction and degree of rotation of volvulus, and ileosigmoid knotting.

RESULTS

Of 442 patients, 271 (61.3%) had sigmoid gangrene. The presence of pregnancy was negatively cor.related with sigmoid gangrene development (P < .05), while comorbid diseases (P < .01), associated shock (P < .01), prolonged symptom duration (P < .05), overrotation (P < .05), and associated ileosigmoid knotting (P < .01) were positively correlated with bowel gangrene. However, no correlation was observed between sigmoid gangrene and the other studied factors.

CONCLUSION

An inverse correlation between pregnancy and sigmoid gangrene was observed. On the other hand, a positive correlation was noted between bowel gangrene and comorbid diseases, shock, prolonged duration of symptoms, overrotation, and associated ileosigmoid knotting.

[Necrotized volvulus of the sigmoid in postpartum]

Le volvulus du sigmoïde compliquant la grossesse est une complication rare avec moins de 80 cas rapportés dans la littérature. Nous rapportons un cas de volvulus du sigmoïde compliquant les suites de couches. Une primigeste de 29-ans s'est présenté avec une douleur abdominale à J3 du post-partum. Une laparotomie exploratrice a révélé un volvulus, nécrosé, du côlon sigmoïde très distendu. Dans notre cas. Le Volvulus du sigmoïde est susceptible d'avoir été précipité par le changement rapide de la taille de l'utérus après l'accouchement. La mobilité colique associée à une distorsion du côlon sigmoïde, doit être gardé à l'esprit chez les patients qui présentent des douleurs abdominales lors du post-partum. Cet article se propose à travers un cas clinique de revoir les données de la littérature et d'engager les principes généraux de prise en charge et de traitement.

Sigmoid volvulus in pregnancy and puerperium: a surgical and obstetric catastrophe. Report of a case and review of the world literature

Sigmoid volvulus is a rare surgical complication occurring in pregnancy and puerperium. Only 84 cases of sigmoid volvulus in pregnancy have been reported in the English literature so far. We have reviewed the available literature on this subject and present another case recently managed at our institution. The available literature suggests that over the years, there has been an improvement in the maternal and fetal outcome for this critical condition, but delay in presentation and a further delay in diagnosis remain a challenge for the treating physicians. Our patient was a 30-week pregnant lady, who presented late with 6 days history of abdominal pain, distension and absolute constipation. She had evidence of multi-organ dysfunction at presentation due to complicated sigmoid volvulus. She was resuscitated and surgical exploration revealed gangrenous large bowel. Bowel resection with diverting ileostomy was performed, but she succumbed to the septic shock due to late presentation. Acute surgical pathology may be overlooked in pregnant patients due to reluctance in radiological workup and a high index of suspicion is essential for enhanced outcome. There is a need to increase the awareness amongst the obstetricians and general practitioners. Early diagnosis and referral and timely surgical intervention could significantly improve the outcome of this surgical and obstetric catastrophe.

[Acute intestinal obstruction in pregnancy - about five cases]

L’occlusion intestinale survient rarement au cours de la grossesse mais elle s’accompagne d’une morbidité et mortalité maternelle et fœtale élevées souvent dues au retard diagnostic et thérapeutique. Les auteurs rapportent cinq cas d’obstruction intestinale gravidique, et revoient la littérature afin de discuter les mécanismes physiopathologiques, les difficultés diagnostiques et thérapeutiques et de proposer une conduite à tenir adéquate.

Volvulus of the Sigmoid Colon during Pregnancy: A Case Report

Colonic obstruction due to sigmoid colon volvulus during pregnancy is a rare but complication with significant maternal and fetal mortality. We describe a case of sigmoid volvulus in a patient with 33 weeks of gestation that developed complete necrosis of the left colon. Case. 27-year-old woman was admitted with 3 days of abdominal distention, vomit, and the stoppage of the passage of gases and feces. She was admitted with poor clinical conditions with septic shock, acute respiratory distress syndrome, and signs of diffuse peritonitis. Abdominal radiography showed severe dilation of the colon with horseshoe signal suggesting a sigmoid volvulus, pneumoperitoneum and we could not we could not identify fetal heartbeats. With a diagnosis of complicate sigmoid volvulus she was underwent to the laparotomy where we found necrosis of all descending colon due to double twist volvulus of the sigmoid. We performed a colectomy with a confection of a proximal colostomy, and closing of the rectal stump. Due to an uncontrollable uterine bleeding during cesarean due, it was required a hysterectomy. The patient had an uneventful postoperative course thereafter and was discharged on a regular diet on the 15th postoperative day.