Recurrent Sigmoid Volvulus in Third Trimester Pregnancy: A Case Report

We present the case of a 34 year old female Gravida 5 Para 4 at 33 weeks and 4 days gestation who presented with lower abdominal pain and constipation. MRI Abdomen and Pelvis demonstrating large bowel obstruction secondary to Sigmoid Volvulus (SV). Patient was initially managed with colonoscopic detorsion but with recurrence of volvulus during the same hospitalization. The second event of volvulus was again treated with colonoscopic detorsion. The patient underwent a C-section due to the recurrence to the volvulus at 34 weeks and 2 days, with the delivery of a pre-term female infant, and exploratory laparotomy concomitantly with bowel resection of the sigmoid and descending colon and colostomy formation. Both procedures were tolerated well by both mother and child without complications. The extremely low incidence of SV along with masking of the clinical presentation by a gravid uterus lead to delay in diagnosis, which is the main reason for devastating outcomes including bowel ischemia, necrosis, perforation and both fetal and maternal death. An effective multidisciplinary approach and prompt diagnosis are critical.