Volvulus of the Pelvic Colon in Pregnancy: A Case Report from the Surgical Department of the National Hospital of Ignace Deen, Teaching University of Conakry, Guinea

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Introduction: Volvulus of the sigmoid colon in pregnancy is a rare and serious complication; prognosis depends on early diagnosis and appropriate surgical management. The high maternal-fetal morbidity is due to delayed diagnosis. Observation: We report a case of sigmoid colon volvulus in a 34-year-old multiparous woman. Her history includes chronic constipation; she has never undergone surgery and her pregnancy is currently being monitored. She was seen in emergency with abdominal pain, cessation of bowel movements and early gas, vomiting on a 26-week, 4-day amenorrhea, which had been evolving for 4 days. Obstetrical examination revealed an open cervix with endo uterine bleeding. The patient expelled a male fetus 2 hours after admission. An unprepared abdominal X-ray revealed a double-legged arch. The patient underwent surgery; the operative lesion being a 2-turn sigmoid volvulus with necrosis of the loop. The necrotic loop was resected and a Hartmann-type colostomy was performed; the peritoneal cavity was cleaned and drained. Results: Preoperative preparation of patients requires a collegial decision involving an obstetrician, a resuscitator-anesthetist and a surgeon, in order to discuss prophylactic tocolysis, corticosteroid therapy for fetal maturation and the surgical indication on a case-by-case basis. The standard surgical treatment is colectomy with restoration of colonic continuity, or colostomy if necrosis is present. Endoscopy is useful for emergency treatment of uncomplicated volvulus. Conclusion: diagnosis of sigmoid volvulus is difficult during pregnancy. It is a medical-surgical emergency requiring multidisciplinary management. The maternal-fetal prognosis depends on early diagnosis and rapid and adequate management. Standard surgical treatment is sigmoidectomy with immediate restoration of colonic continuity; in cases of necrosis, colostomy is indicated. Endoscopy is of vital importance in the emergency treatment of uncomplicated volvulus.

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