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Ibtihal Mahboob

Ibtihal Mahboob

King Abdul Aziz University, KSA

Title: Endoscopic detorsion of sigmoid volvulus in pregnancy-A case report and literature

Biography

I.Y.M. has completed her Saudi Board (PhD) of iternal medicine ,currently at the end of second year in gastroenterology fellowship .

H.A.J. Assistant Professor ,internal medicine department KAAUJ.

L.K.A Assistant Professor,  radiology deparment KAAUJ.

Abstract

Background: Sigmoid volvulus is a very rare condition causing intestinal obstruction in pregnancy associated with extremely high rate of morbidity and mortality for both mother and fetus, early diagnosis based on clinical judgment and use of modern imaging modalities are required for achieving better results and avoiding any surgical intervention. Case report: We report the case of a 23-week pregnant lady, present with severe abdominal distention and constipation, diagnosis was achieved using magnetic resonance image, emergency flexible sigmoidoscopy with detorsion of volvulus done successfully with no complication to the mother or fetus, she was maintained on stool softener and remained well on follow-up. Discussion: We have reviewed the available literature on this topic, as of 2017, less than 100 cases had been reported since first reported case in 1885, most of them ended by surgical resection of gangrenous part of the colon and the need for colostomy. One case had been managed by endoscopy is reported in Brunei. Sigmoid volvulus is the most cause of intestinal obstruction during pregnancy accounting for up to 44% of reported cases. Delay in diagnosis usually goes back to similarity between common gastro-enteric symptoms in pregnancy that can mask truly obstructive one, and also hesitate in use of radiologic image for evaluation.

Conclusions: Effective management represents a challenge, as a delayed presentation and diagnosis will lead to catastrophic feto-maternal complications. A high incidence of clinical suspicion and timely intervention are the key to a favourable outcome.