Sigmoid volvulus in pregnancy: Current approach in diagnosis and treatment

Abstract

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

Kaynakça

1. 1. Alavi K, Poylin V, Davids JS, Patel SV, Felder S, Valente MA, et al. The American Society of Colon and Rectal Surgeons clinical practice guidelines for the management of colonic volvulus and acute colonic pseudo-obstruction. Dis Colon Rectum. 2021;64(9):1046-57.
2. 2. Atamanalp SS. Endoscopic Decompression of Sigmoid Volvulus: Review of 748 Patients. J Laparoendosc Adv Surg Tech A. 2021 Nov 9. doi: 10.1089/lap.2021.0613. Epub ahead of print.
3. 3. Alrahmani L, Rivington J, Rose CH. Recurrent volvulus during pregnancy: Case report and review of the literature. Case Rep Obstet Gynecol. 2018;41510754.
4. 4. Atamanalp SS, Kisaoglu A, Ozogul B, Kantarci M, Disci E, Bulut OH, et al. Sigmoid volvulus complicating pregnancy: A case report. Eurasian J Med. 2015;47(1):75-6.
5. 5. Ghahremani S, Razmjouei P, Layegh P, Tavakolian A, Ghazanfarpour M, Shoaee F, et al. A case of sigmoid volvulus in pregnancy: A rare emergency in pregnancy. Int J Pediatr. 2020;8(1):10743-7.
6. 6. Lodhia J, Magoma J, Tendai J, Msuya D, Suleiman J, Chilonga K. Sigmoid volvulus in pregnancy: a case report. J Med Case Rep. 2021;15:554.
7. 7. Atamanalp SS, Ozturk G. Sigmoid volvulus in pregnancy. Turk J Med Sci. 2012;42(1):9-15.
8. 8. Tesniere M, Arnoult A, Roger N. Sigmoid volvulus in pregnancy. J Emerg Med. 2018;54(6):129-31.

9. 9. Serafeimidis C, Waqainabete I, Creaton A, Vakamacawai E, Kumar R. Sigmoid volvulus in pregnancy: case report and literature review. Clin Case Rep. 2016;4(8):759-6.
10. 10. Cortez N, Berzosa M, Muddasani K, Ben-David K. Endoscopic decompression of recurrent sigmoid volvulus in pregnancy. J Invest Med High Impact Case Rep. 2020;8:1-3.
11. 11. Jawa HA. Endoscopic management of recurrent sigmoid volvulus in pregnancy: a case report. Med Sci. 2019;23(97):354-5.
12. 12. Amed FG, Campanharo FF, Ju36ior EA, Souza RT, Akiba RT, Mattar R, et al. Sigmoid volvulus during pregnancy with endoscopic treatment. J Obstet Gynaecol 2016;287-8.
13. 13. Rottenstreich M, Mosmar K, Ehrlich Z, Kitroser E, Grisaru-Granosvky S. Flexible endoscopic decompression for treatment of sigmoid volvulus in pregnancy. Eur J Obstet Gynecol Reprod Biol. 2019;242:182-5.
14. 14. Wu C, Zhu X, Liu W, Ruan T, Tao K. Sigmoid volvulus during late pregnancy: a case report and literature review. Int J Clin Exp Med. 2017;10:167331673-8.