A Rare Case Report of the Successful Management of Perforated Sigmoid Volvulus in a Pregnant Woman With Massive Pneumoperitoneum: First Case in Yemen

Abstract

Sigmoid volvulus during pregnancy is an extremely rare condition that presents as intestinal obstruction and can lead to severe complications for both the mother and fetus if not promptly diagnosed and treated. To our knowledge, this is the first documented case in Yemen. We report a case of a 39-year-old pregnant woman at 32 weeks of gestation who presented with acute abdominal pain, constipation, and signs of peritonitis. Diagnostic imaging was limited due to the pregnancy, but an ultrasound revealed fluid collection in the pelvis and massive pneumoperitoneum, suggesting a rupture of the hollow viscus. An emergency exploratory laparotomy confirmed a perforated sigmoid volvulus with necrosis of the sigmoid wall; as a result, we resected a nonviable colon and performed Hartmann's procedure. After five days, we discharged the patient in excellent condition, and the fetus was monitored as healthy. Diagnosis of sigmoid volvulus during pregnancy is challenging due to the overlap of symptoms with normal pregnancy. Prompt surgical intervention is crucial to prevent maternal and fetal complications. This case highlights the importance of a multidisciplinary approach involving general surgeons, obstetricians, and neonatologists in managing this rare condition. Early diagnosis and treatment are essential for improving maternal and fetal outcomes in cases of sigmoid volvulus during pregnancy.

Keywords: intestinal obstruction; peritonitis; pregnancy; sigmoid volovlus; yemen.

Figure 1. Intraoperative assessment showing a perforated sigmoid volvulus with necrosis of the sigmoid wall

Figure 2. Resected nonviable part of the colon