P3084 - Management of Recurrent Sigmoid Volvulus in Pregnancy: A Case Report

Islam Mohamed, MD¹, Noor Hassan, MD¹, Ifrah Fatima, MD¹, Rawan Rajab, MD², Mohamed Ahmed, MD¹, Maya Mahmoud, MD³, Adel Muhana, MD¹, Hassan Ghoz, MD^1
1University of Missouri-Kansas City, Kansas City, MO; ²University of Missouri Kansas City, Kansas City, MO; ³Saint Louis University, St. Louis, MO

Introduction: Sigmoid volvulus in pregnancy is associated with high rates of maternal and fetal complications. There is a high risk of delay in diagnosis due to an overlapping picture with physiological changes of pregnancy. We present a case of a young pregnant patient with recurrent sigmoid volvulus who was treated successfully with endoscopic detorsion and sigmoid resection.

Case Description/Methods: This is a case of a 20-year-old 20 weeks pregnant female with a history of sigmoid volvulus treated with endoscopic detorsion 4 months ago and chronic hepatitis B on tenofovir. She presented to the hospital with diffuse abdominal pain and constipation, reporting that she had not passed gas or had a bowel movement in a week. Laboratory work revealed mild hypokalemia, mild anemia, and a high hepatitis B DNA quant test result of >100000000 IU/mL. CT of the abdomen showed markedly dilated large bowel loops measuring up to 11 cm in diameter, suggestive of colonic volvulus. GI recommended emergent colonoscopy with endoscopic decompression, water enemas, laxatives, nasogastric tube placement, and rectal tube placement. The emergent colonoscopy revealed friable mucosa, swirl sign in the mid ascending and sigmoid colon, and both were successfully traversed with endoscopic detorsion with stool and flatus passage following intervention. General surgery discussed with the patient the risks and benefits of proceeding with an open sigmoidectomy and colostomy creation due to recurrence and ultimately performed exploratory laparotomy with open sigmoid colon resection with end colostomy. The patient and the fetus tolerated the procedure with no intraoperative complications. She eventually showed improvement in bowel function with appropriate stool collection in the ileostomy bag. She was discharged after 10 days of hospital stay in stable condition.

Discussion: Sigmoid volvulus very rare in pregnancy, and can present with nonspecific symptoms including abdominal pain and constipation, which can be disregarded as pregnancy-related symptoms. Early recognition is critical for appropriate intervention, which includes nasogastric decompression, electrolyte repletion, fluids, and laxatives. Recurrent volvulus and cases with bowel necrosis typically require surgical intervention, as seen in our patient. Endoscopic intervention can be both diagnostic and therapeutic, allowing for confirmation of diagnosis as well as detorsion. Although rare, sigmoid volvulus should remain on the differential diagnosis for abdominal pain in pregnancy.



Disclosures:


Islam Mohamed, MD¹, Noor Hassan, MD¹, Ifrah Fatima, MD¹, Rawan Rajab, MD², Mohamed Ahmed, MD¹, Maya Mahmoud, MD³, Adel Muhana, MD¹, Hassan Ghoz, MD¹. P3084 - Management of Recurrent Sigmoid Volvulus in Pregnancy: A Case Report, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.