Sigmoid Volvulus in Second Trimester is Challenge to Obstetric and Surgical Departments at St. Francis Referal Hospital, Kilombero, Tanzania

Abstract

Introduction: Intestinal obstruction is rare in pregnant with the incidence ranging between 1:1500 and 1:66431 deliveries whereby the sigmoid volvulus is the most cause in all causes. Early diagnosis is the most important step to prevent possible maternal and fetal complications. On the other hand, premature delivery and maternal death are among the complications. Case report: A 25 years Gravida 4, para 3, with 2 living at gestation age of 20 weeks who presented at St Francis Hospital with three days of colicky abdominal pain, associated with abdominal distension and constipation. Abdominal X-ray revealed a dilated large bowel and coffee bean sign while abdominal ultrasound showed a single living intrauterine fetus. Emergency laparotomy was done in which the findings revealed a gangrenous and twisted sigmoid at its mesenteric axis by 360 degrees. End to end anastomosis was done following bowel resection. Abortion of a living baby occurred four hours after surgery who died after 24 hours. The patient was discharge at day six post operation in good health. Conclusion: Sigmoid volvulus is rare in non pregnant females but more frequent in pregnant ones. Obstetric complication may mimic the SV findings which may lead to delay in diagnosis. The early of both diagnosis and surgical intervention are recommended to prevent maternal and fetal complications such as preterm delivery and intrauterine death.