SIGMOID VOLVULUS IN PREGNANCY

Abstract

Objectives. Sigmoid volvulus in pregnancy has a low incidence, but presents a challenge for clinicians, due to the lack of pathognomonic signs and mimicking a series of acute pathologies, but requiring a different approach. Early diagnosis is absolutely necessary to avoid the occurrence of complications, as the relativity between the increased time since onset and mortality has been demonstrated. Imaging investigations, such as radiography, computed tomography and magnetic resonance imaging, provide the necessary data for establishing the diagnosis, being certain characteristic signs of this pathology. The treatment is oriented towards volume and hydroelectrolytic rebalancing, followed by endoscopic resolution, in the absence of perforation. The presence of this complication requires surgical treatment. The aim of the study was the evaluation of the clinical, paraclinical and evolutive features of this pathology, for early diagnosis.

Materials and methods. To create this article, the bibliographic sources from the PubMed, Google Scholar and Medline online database were studied. The search was performed using the following keywords: "sigmoid volvulus", "pregnancy", "sigmoid torsion". Information on characteristic clinical manifestations, diagnostic methods and treatment options was researched and processed, and the collected data was analyzed and compared.

Results. Sigmoid volvulus presents a clinical picture of intestinal occlusion, and can mimic a wide spectrum of acute surgical and obstetric pathologies. Imaging diagnosis is effective, as a series of characteristic signs are present. Endoscopic decompression and torsion is the standard procedure in the absence of perforation, with a very high success rate, and which can be repeated if necessary, to delay delivery in the case of patients with a short gestation period, with subsequent postpartum surgical resolution.

Conclusions. Gestational sigmoid volvulus is a rare pathology that requires an early diagnosis to avoid evolutionary complications. Pregnant patients with sigmoid volvulus should be approached by a multidisciplinary team. The occurrence of perforation is an indication for immediate surgical treatment, regardless of the term.