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Sigmoid volvulus in a parturient requiring laparotomy and cesarean delivery: a case report
Abstract Number: S3D-1
Abstract Type: Case Report/Case Series
Sigmoid volvulus in pregnancy can be life threatening to both mother and fetus. Although it is extremely rare, it carries with it a significant associated mortality and morbidity. Furthermore, undertaking a laparotomy in pregnancy poses its own unique anesthetic risks and challenges.
We report a case of a previously fit, 33 year old multiparous woman at 33 +6 weeks gestation requiring emergency laparotomy for acute sigmoid volvulus. She initially presented to her local hospital with vomiting, generalised abdominal pain and reduced bowel movements and was discharged home the same day. 24hrs later she was admitted to our institution with persisting symptoms. Ultrasound imaging of her urinary tract and pelvis was unremarkable. Her symptoms progressed to abdominal distension with reduced bowel sounds and sigmoid volvulus was diagnosed on abdominal magnetic resonance imaging scan. An attempt at endoscopic decompression under sedation was unsuccessful and revealed signs of early bowel ischemia. Following a multidisciplinary meeting to discuss her treatment options, she underwent emergency cesarean delivery with laparotomy, enterostomy and sigmoidopexy under general anaesthetic. A thoracic epidural was sited prior to induction for intra- and post-operative analgesia as the extent of surgical intervention was not certain at that time. Fortunately, no bowel resection was required and she was extubated immediately post op. She was discharged home 6 days later after an uneventful recovery. Her newborn was delivered with Apgar scores of 5 and 7, at 1 and 5 minutes, respectively, and required mechanical ventilation for <24hrs but was discharged from hospital after 26 days.
The estimated prevalence of intestinal obstruction in pregnancy is between 1:1,500 and 1:66,3461, of which 24% are thought to be caused by sigmoid volvulus. Because of the rarity of the condition, early diagnosis and treatment requires a high index of suspicion as symptoms are often masked by the pregnancy itself. Delayed diagnosis increases the risk of bowel ischemia, bowel resection and mortality of both mother and fetus. The literature is consistent in highlighting the severity of this condition and the need to treat it as a surgical emergency.
1. Perdue PW, Johnson HW Jr, Stafford. Intestinal obstruction complicating pregnancy. Am J Sure. 1992;164:384-388.
2. Juhasz-Böss I, Solomayer E, Strik M, Raspé C. Abdominal surgery in pregnancy - an interdisciplinary challenge. Dtsch Arztebl Int. 2014;111:465-72.