Sigmoid volvulus: mischief from a gravid uterus

Abstract

A 39‐year‐old gravida 2 para 1 female at 32\u2009weeks gestation presented with 3\u2009days of abdominal pain, distension, nausea and diarrhoea. Her presentation was associated with tenesmus and anorexia. Her past history was significant for an elective laparoscopic left‐sided pyeloplasty for congenital pelviureteric junction obstruction. On examination, the patient was afebrile and haemodynamically stable. The foetus was not distressed according to cardiotocography assessment. Her abdomen was distended and tympanic with generalized tenderness. Bowel sounds were high pitched and tinkling. A digital rectal examination revealed an empty rectum with no masses or faeces. The patient was hypokalaemic and hyponatraemic at 3.1 and 129\u2009mmol/L, respectively. Her white cell count was 20.3 ×\u2009109/L, of which 17.87\u2009×\u2009109/L were neutrophils. Abdominal plain films were concerning for a large bowel obstruction, with marked distension of large bowel proximal to the descending colon and an absence of gas in the left lower quadrant (Fig. 1). A nasogastric tube was placed with minimal effect on symptomology and a magnetic resonance imaging (MRI) was performed. This demonstrated spiralling of the sigmoid colon at the transition point of the obstruction, concerning for a sigmoid volvulus (Figs 2, 3). Initial attempt at decompression with rigid sigmoidoscopy failed. Colonoscopic decompression was performed, successfully reducing the volvulus. The entire length of colon had viable mucosa on endoscopic examination. A flatus tube was placed during the procedure and removed on the following day. Her condition improved, and she was discharged on the third day.