Sigmoid volvulus in pregnancy: Current approach in diagnosis and treatment

Background/Aim: Sigmoid volvulus (SV) is an uncommon disease worldwide, while SV complicating

pregnancy is extremely rare. The aim of this study is to evaluate the current diagnostic and therapeutic

options in SV during pregnancy in a case series.

Methods: The clinical data of 1,046 patients with SV, including 11 pregnant women, were reviewed

retrospectively. Age, gestation period, previous history of volvulus, presence of comorbidities, duration of

complaints, symptoms, signs, diagnostic tools, treatment procedures and prognosis were noted. Rigid or

flexible sigmoidoscopy and magnetic resonance imaging (MRI) were used in the diagnosis, while

abdominal X-ray and computerized tomography (CT) were avoided. Stable patients were treated with

endoscopic decompression, while emergent surgery was needed in complicated cases with necrosis,

peritonitis, or unsuccessful endoscopic decompression.

Results: The mean age was 31.0 years (24-39 years). All cases were multiparous. Of the patients, 6

(54.5%) were in third trimester, 4 (36.4%) were in second trimester, and 1 (9.1%) was in first trimester.

SV was diagnosed by endoscopy in 6 patients (54.5%), by magnetic resonance imaging (MRI) in 2

(18.2%), and during laparotomy in 3 (27.3%) patients. 6 patients (54.5%) were decompressed by

sigmoidoscopy, while 5 cases (45.5%) were treated with surgery. One patient (9.1%) was lost due to toxic

shock arising from sigmoid necrosis, while a stillbirth (9.1%) was developed following the surgical

procedure in the same case.

Conclusion: Although common findings including abdominal pain, obstipation and distention are

prominent clinical features of SV, some clinical findings of pregnancy may cloud the pathology during

pregnancy. We recommend sigmoidoscopy or MRI in the diagnosis of pregnant patients with suspected

SV. Although enlarged uterus is generally thought as an impediment factor for endoscopic decompression,

flexible sigmoidoscopy is currently preferred in the treatment of uncomplicated and non-gangrenous

patients, while gangrenous or complicated cases are required emergency surgery regardless of the

gestation period.

Keywords: Sigmoid volvulus, Pregnancy, Endoscopy, Surgery