Cecal Volvulus in Pregnancy, a Diagnostic Dilemma and Management: A Case Report and Literature Review

Introduction: Colonic volvulus is an unusual cause of intestinal obstruction in pregnant women. Cecal volvulus, second only to sigmoid volvulus, accounts for 1-2% of all cases of intestinal obstruction. Due to its infrequent occurrence, only a few articles have documented its diagnosis and management among pregnant women, and we assume this to be the first reported case in Ethiopia, as per the authors' knowledge.Case Presentation: A 26-year-old Gravida 3, Para 2 mother who has had amenorrhea for the last five months presents with a complaint of upper abdominal cramps with associated vomiting, which is bilious, upper abdominal distension, and obstipation of five-hour duration. Her vital signs were in the normal range, and she had upper abdominal tenderness. Plain abdominal radiography suggested a cecal volvulus and exploratory laparotomy, a right hemicolectomy, and end-to-side ileotransverse colon anastomosis was performed. The postoperative course was uneventful. Discussion: The cecal volvulus is an axial twist of the cecum, segment of the terminal ileum, and ascending colon along its mesentery, resulting in closed-loop obstruction with early vascular compromise and ischemia. It requires an anatomic prerequisite, which makes the cecum hypermobile, unlike the sigmoid volvulus. Diagnosis is challenging in pregnant women, as there are many differential diagnoses and a reluctance to request radiological imaging.Conclusion: A high index of suspicion is of paramount importance whenever a pregnant woman comes with a complaint of persistent abdominal cramps and obstipation. Early diagnosis and management are crucial to improve patients' outcome. Plain abdominal radiography is the safest option of imaging modality in low-resource areas where magnetic resonance imaging (MRI) is not available during pregnancy whenever intestinal obstruction is considered. Right hemicolectomy is the preferred surgical option.