Sigmoid Volvulus in Pregnancy Assessed by Contrast-Enhanced Computed Tomography Scanning

Sigmoid volvulus requires urgent treatment, and it is particularly rare among pregnant women without a history of laparotomy. A delay in diagnosis may lead to serious consequences for the mother and fetus, and a rapid diagnosis and treatment in this setting is essential. The patient was a 19-year-ol...

Full description

Saved in:
Bibliographic Details
Main Authors: Toshiaki Watanabe, Tadatsugu Kinjo, Yoshino Kinjyo, Hayase Nitta, Hitoshi Masamoto, Keiko Mekaru, Yoichi Aoki
Format: Article
Language:English
Published: Wiley 2021-01-01
Series:Case Reports in Obstetrics and Gynecology
Online Access:http://dx.doi.org/10.1155/2021/6692483
Tags: Add Tag
No Tags, Be the first to tag this record!
_version_ 1832550105429835776
author Toshiaki Watanabe
Tadatsugu Kinjo
Yoshino Kinjyo
Hayase Nitta
Hitoshi Masamoto
Keiko Mekaru
Yoichi Aoki
author_facet Toshiaki Watanabe
Tadatsugu Kinjo
Yoshino Kinjyo
Hayase Nitta
Hitoshi Masamoto
Keiko Mekaru
Yoichi Aoki
author_sort Toshiaki Watanabe
collection DOAJ
description Sigmoid volvulus requires urgent treatment, and it is particularly rare among pregnant women without a history of laparotomy. A delay in diagnosis may lead to serious consequences for the mother and fetus, and a rapid diagnosis and treatment in this setting is essential. The patient was a 19-year-old primiparous woman. She complained of repeated exacerbations and remissions of abrupt lower abdominal pain for the past 2 days and was transported to our hospital at 33 weeks of gestation. Ultrasonography revealed no placental thickening, and maternal bowel dilation was difficult to identify. Plain abdominal X-ray showed a dilated colon on the left side of the abdomen. Contrast-enhanced CT scan of the abdomen revealed a volvulus on the dorsal side of the uterus. The proximal end of the transverse to sigmoid colon was markedly dilated, and the distal end was collapsed. The elevated lactate level on blood gas analysis suggested intestinal ischemia. She was suspected of having a sigmoid volvulus at 33 weeks and 3 days of gestation. We decided to perform a cesarean section to secure the operative field for an intestinal resection following delivery. A male weighing 1840 g with Apgar scores 8/8 was delivered. The sigmoid colon was approximately 80 cm in length. A 360-degree clockwise rotation of was observed with a very distended but viable sigmoid loop. Following reduction of the volvulus, the sigmoid colon was fixed to the left side of the peritoneum. The mother had an uneventful postoperative course, and the infant was discharged without any sequelae. This case demonstrates two important lessons. First, sigmoid volvulus can occur in pregnant women even if they never had a laparotomy. Second, abdominal contrast-enhanced CT is useful for rapid diagnostic and treatment decisions relative to this pathology.
format Article
id doaj-art-e90cbaef4f5340f08046443e853c36f8
institution Kabale University
issn 2090-6684
2090-6692
language English
publishDate 2021-01-01
publisher Wiley
record_format Article
series Case Reports in Obstetrics and Gynecology
spelling doaj-art-e90cbaef4f5340f08046443e853c36f82025-02-03T06:07:40ZengWileyCase Reports in Obstetrics and Gynecology2090-66842090-66922021-01-01202110.1155/2021/66924836692483Sigmoid Volvulus in Pregnancy Assessed by Contrast-Enhanced Computed Tomography ScanningToshiaki Watanabe0Tadatsugu Kinjo1Yoshino Kinjyo2Hayase Nitta3Hitoshi Masamoto4Keiko Mekaru5Yoichi Aoki6Department of Obstetrics and Gynecology, Graduate School of Medicine, University of the Ryukyus, 207 Uehara Nishihara, Okinawa 903-0215, JapanDepartment of Obstetrics and Gynecology, Graduate School of Medicine, University of the Ryukyus, 207 Uehara Nishihara, Okinawa 903-0215, JapanDepartment of Obstetrics and Gynecology, Graduate School of Medicine, University of the Ryukyus, 207 Uehara Nishihara, Okinawa 903-0215, JapanDepartment of Obstetrics and Gynecology, Graduate School of Medicine, University of the Ryukyus, 207 Uehara Nishihara, Okinawa 903-0215, JapanDepartment of Obstetrics and Gynecology, Graduate School of Medicine, University of the Ryukyus, 207 Uehara Nishihara, Okinawa 903-0215, JapanDepartment of Obstetrics and Gynecology, Graduate School of Medicine, University of the Ryukyus, 207 Uehara Nishihara, Okinawa 903-0215, JapanDepartment of Obstetrics and Gynecology, Graduate School of Medicine, University of the Ryukyus, 207 Uehara Nishihara, Okinawa 903-0215, JapanSigmoid volvulus requires urgent treatment, and it is particularly rare among pregnant women without a history of laparotomy. A delay in diagnosis may lead to serious consequences for the mother and fetus, and a rapid diagnosis and treatment in this setting is essential. The patient was a 19-year-old primiparous woman. She complained of repeated exacerbations and remissions of abrupt lower abdominal pain for the past 2 days and was transported to our hospital at 33 weeks of gestation. Ultrasonography revealed no placental thickening, and maternal bowel dilation was difficult to identify. Plain abdominal X-ray showed a dilated colon on the left side of the abdomen. Contrast-enhanced CT scan of the abdomen revealed a volvulus on the dorsal side of the uterus. The proximal end of the transverse to sigmoid colon was markedly dilated, and the distal end was collapsed. The elevated lactate level on blood gas analysis suggested intestinal ischemia. She was suspected of having a sigmoid volvulus at 33 weeks and 3 days of gestation. We decided to perform a cesarean section to secure the operative field for an intestinal resection following delivery. A male weighing 1840 g with Apgar scores 8/8 was delivered. The sigmoid colon was approximately 80 cm in length. A 360-degree clockwise rotation of was observed with a very distended but viable sigmoid loop. Following reduction of the volvulus, the sigmoid colon was fixed to the left side of the peritoneum. The mother had an uneventful postoperative course, and the infant was discharged without any sequelae. This case demonstrates two important lessons. First, sigmoid volvulus can occur in pregnant women even if they never had a laparotomy. Second, abdominal contrast-enhanced CT is useful for rapid diagnostic and treatment decisions relative to this pathology.http://dx.doi.org/10.1155/2021/6692483
spellingShingle Toshiaki Watanabe
Tadatsugu Kinjo
Yoshino Kinjyo
Hayase Nitta
Hitoshi Masamoto
Keiko Mekaru
Yoichi Aoki
Sigmoid Volvulus in Pregnancy Assessed by Contrast-Enhanced Computed Tomography Scanning
Case Reports in Obstetrics and Gynecology
title Sigmoid Volvulus in Pregnancy Assessed by Contrast-Enhanced Computed Tomography Scanning
title_full Sigmoid Volvulus in Pregnancy Assessed by Contrast-Enhanced Computed Tomography Scanning
title_fullStr Sigmoid Volvulus in Pregnancy Assessed by Contrast-Enhanced Computed Tomography Scanning
title_full_unstemmed Sigmoid Volvulus in Pregnancy Assessed by Contrast-Enhanced Computed Tomography Scanning
title_short Sigmoid Volvulus in Pregnancy Assessed by Contrast-Enhanced Computed Tomography Scanning
title_sort sigmoid volvulus in pregnancy assessed by contrast enhanced computed tomography scanning
url http://dx.doi.org/10.1155/2021/6692483
work_keys_str_mv AT toshiakiwatanabe sigmoidvolvulusinpregnancyassessedbycontrastenhancedcomputedtomographyscanning
AT tadatsugukinjo sigmoidvolvulusinpregnancyassessedbycontrastenhancedcomputedtomographyscanning
AT yoshinokinjyo sigmoidvolvulusinpregnancyassessedbycontrastenhancedcomputedtomographyscanning
AT hayasenitta sigmoidvolvulusinpregnancyassessedbycontrastenhancedcomputedtomographyscanning
AT hitoshimasamoto sigmoidvolvulusinpregnancyassessedbycontrastenhancedcomputedtomographyscanning
AT keikomekaru sigmoidvolvulusinpregnancyassessedbycontrastenhancedcomputedtomographyscanning
AT yoichiaoki sigmoidvolvulusinpregnancyassessedbycontrastenhancedcomputedtomographyscanning