Cecal Volvulus in a Multiple-Gestation Pregnancy

• Published in: Obstetrics and gynecology (New York. 1953) Vol. 114; no. 2; pp. 475 - 477
• Main Authors: Chase, Daniel M., Sparks, Dorothy A., Dawood, Murtaza Y., Perry, Earnest
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD by The American College of Obstetricians and Gynecologists 01-08-2009; Lippincott Williams & Wilkins
• Subjects: Adult; Biological and medical sciences; Cecal Diseases - diagnosis; Cecal Diseases - surgery; Female; Gynecology. Andrology. Obstetrics; Humans; Intestinal Volvulus - diagnosis; Intestinal Volvulus - surgery; Medical sciences; Pregnancy; Pregnancy Complications - diagnosis; Pregnancy Complications - surgery; Pregnancy, Multiple; Twins; Volvulus; Multiple pregnancy; Obstetrics; Cecum; Gynecology
• ISSN: 0029-7844; 1873-233X
• DOI: 10.1097/AOG.0b013e3181989578

Intestinal obstruction during pregnancy is rare, with volvulus being responsible for about 25% of cases.
We present a case in which a woman in the 12th week of a twin gestation presented with abdominal pain and distension. She was initially diagnosed with an ileus, and radiological studies at the time were deferred. The patient's symptoms worsened, and eventually she was taken to surgery for a diagnostic laparoscopy, which revealed a cecal volvulus with ischemic changes. A right hemicolectomy with primary anastomosis was performed.
Volvulus in pregnancy carries a high mortality rate, often because diagnosis is delayed due to avoidance of radiography and because of similarity of symptoms to other clinical entities. A high index of suspicion for volvulus must be maintained when a pregnant patient presents with obstructive symptoms. Abdominal radiographs may be justified in aiding the diagnosis, and diagnostic laparoscopy is a viable alternative when the patient has an acute abdomen.