The most common causes of intestinal obstruction in pregnancy are adhesion, intestinal volvulus, intussusception, carcinoma, hernia and appendicitis . In 1885, Braun was GSK2879552 nmr the
first surgeon to describe a case of sigmoid volvulus during pregnancy . Intestinal obstruction due to sigmoid volvulus during pregnancy remains extremely rare and is of extreme gravity especially if not recognized and treated precociously . The clinical presentation is similar to that in non-pregnant females, but is masked by the enlarged uterus and the physiological changes of pregnancy. The sigmoid volvulus occurs when the sigmoid colon wraps around itself and its mesentery. The increasing size of the uterus may elevate a mobile sigmoid colon from the pelvis and produce a Salubrinal partial obstruction either due to pressure or kinking of this portion of the bowel . This difficult presentation, along with a delay in diagnosis, is the main reason behind the high morbidity and mortality of this condition. Outcomes may include bowel ischemia, necrosis, gangrene, perforation, peritonitis, preterm delivery and both fetal and maternal death . In this report, we present a patient diagnosed
with sigmoid volvulus during pregnancy who was initially treated non-operatively by detorsion with flexible endoscopy and underwent elective resection of the sigmoid colon after delivery. We also undertook Combretastatin A4 a comprehensive review of the literature. Case presentation A 33-year-old female of 32 weeks’ gestation, para 2 gravida 3, presented with generalized abdominal pain of 2 days’ duration. The pain was gradually ZD1839 purchase increasing in intensity, colicky in nature and not associated with vomiting, fever or anal bleeding. On the second day, it was mainly felt in the right and left lower quadrants with abdominal distension. She passed flatus until 8 h prior to presentation, after which she was completely constipated. The patient related this symptom to her pregnancy, but as her symptoms did not improve she presented to Gynecological and
Obstetric emergency department. The patient had no significant medical history, except two previous cesarean sections (the last one 5 years ago). On clinical examination she was afebrile, her pulse rate was 100, blood pressure 120/80 mmHg and oxygen saturation 99%. Her abdomen was distended and soft with mild tenderness mainly over the left iliac fossa, and palpable bowel loop in the upper abdomen. Bowel sounds were audible but sluggish. Her gravid uterus corresponded to 32 weeks’ gestation. Anal examination showed no fissure or prolapsed piles. Stools with no blood were found in the rectum. Fetus viability was assessed by the gynecologist, and was normal and alive. Routine laboratory studies were significant only for an elevated white blood cell count of 12.4 K/æL, which could have been due to normal physiological response in pregnancy.