Sigmoid volvulus in a pregnant female: case presentation

Intestinal obstruction (IO) in pregnancy is uncommon with an incidence ranging from 1 in 1500 to 1 in 66 431 deliveries. Sigmoid volvulus (SV) in pregnancy is a very rare entity that can be associated with extremely high rates of morbidity and mortality for both mother and fetus. A 24-year-old pregnant woman presented to the emergency department with a 4-day history of abdominal pain, absolute constipation, and persisting vomiting that were associated with chills. Ultrasound showed marked dilatation of the bowel loops all over the abdomen with notable mass like doughnut-shaped bowel at the left side of the abdomen. Magnetic resonance imaging (MRI) showed a picture of mechanical large bowel obstruction likely due to adhesion vs. volvulus of the splenic flexure. Laparotomy through a midline incision was performed and revealed a gangrenous highly ballooned sigmoid with 360-degree volvulus behind the gravid uterus and reaching the epigastrium. A cesarean section was done. The vascularity of sigmoid was compromised; thus, a resection and Hartman's was done. Closure of colostomy with restoration of intestinal continuity was successfully done 3 months later.