Recurrent Volvulus during Pregnancy: Case Report and Review of the Literature

Abstract

Introduction: Sigmoid colon volvulus (SV) represents the most common etiology of antepartum gastrointestinal obstruction, with repetitive antepartum episodes rarely reported.

Case presentation: A 25-year-old multiparous patient with history of SV at 26 weeks in her previous pregnancy presented with recurrent episodes of SV at 32 0/7, 32 4/7, 37 0/7, and 38 1/7 weeks successfully managed with colonoscopic decompression. Labor was successfully induced at 38 4/7 weeks, and she experienced two further episodes on postpartum days #1 and #32 also treated with colonoscopic decompression, followed by laparoscopic resection.

Conclusion: Successful treatment of antepartum SV with colonoscopic decompression does not preclude recurrence later in gestation and in future pregnancies.

Figure 1

Magnetic resonance imaging without contrast performed at 32 weeks' gestation. There is marked distention of the sigmoid colon beginning at the level of the sigmoid along the left lateral aspect of the uterus where there appears to be a small, early (90 degree) twist of the sigmoid colon. The fetus may also be seen in this image.

Figure 2

Computer tomography imaging with intravascular contrast performed on postpartum day 1. There is twisting of the mesentery and focal mesenteric edema in the mid lower abdomen. The findings are consistent with sigmoid volvulus.