SIGMOID VOLVULUS IN PREGNANCY

During pregnancy, intestinal obstruction due to sigmoid volvulus is ex tremely rare. Only 73 cases have been reported. A 24-year-old black wo man, gravida 2, para 1, presented during Week 36 of an otherwise uneve ntful pregnancy, with intermittent abdominal pain and constipation, an d no history of nausea, vomiting, fever, chills, previous medical prob lems, or prior abdominal surgery. Her previous pregnancy was a spontan eous vaginal delivery of a normal full-term neonate. On examination, s he was afebrile, with abdominal tenderness. Laboratory studies reveale d elevated WBC count of 13,500. She was admitted and given a Fleet(R) enema, with no result or change in abdominal pain. Pain worsened; reex amination of her cervix revealed 3 cm dilation. After Pitocin augmenta tion, a viable male infant with Apgars of 7 and 9 was delivered. Postp artum, abdominal pain continued, with worsening abdominal distention. Radiographs revealed a massively distended colon. Physical examination 12 hours postdelivery indicated peritonitis. Exploratory laparotomy r evealed volvulated, gangernous, massively distended sigmoid colon. The sigmoid colon was resected and Hartmann's colostomy performed. She wa s discharged on postoperative Day 4. Sigmoid volvulus complicating pre gnancy is an uncommon and potentially devastating development that sho uld be suspected with worsening abdominal pain and evidence of bowel o bstruction. Prompt intervention is necessary to minimize maternal and fetal morbidity.