Sigmoid Volvulus Complicating the Postpartum Period After Cesarean Section: A Rare Case Report: Case Report

Bouali Ichrak; Ilias El Azhari; Zaineb Moustaquime; Nassima Fakhiri; Abdelhak Ettaoussi; Abdessamad Majd; Khadija Kamal; Mounir Bouali; Abdelilah El Bakouri; Khalid El Hattabi

doi:10.58372/2835-6276.1398

Authors

Bouali Ichrak Department of General Surgery, University Hospital Center Ibn Rochd, Faculty of Medicine and Pharmacy, University of Hassan II, Casablanca, Morocco
Ilias El Azhari Department of General Surgery, Faculty of Medicine and Pharmacy, Ibn Rochd University Hospital Center, Hassan II University, Casablanca, Morocco https://orcid.org/0009-0008-2192-1817
Zaineb Moustaquime Department of General Surgery, University Hospital Center Ibn Rochd, Faculty of Medicine and Pharmacy, University of Hassan II, Casablanca, Morocco
Nassima Fakhiri Department of General Surgery, University Hospital Center Ibn Rochd, Faculty of Medicine and Pharmacy, University of Hassan II, Casablanca, Morocco
Abdelhak Ettaoussi Department of General Surgery, Faculty of Medicine and Pharmacy, Ibn Rochd University Hospital Center, Hassan II University, Casablanca, Morocco
Abdessamad Majd Department of General Surgery, Faculty of Medicine and Pharmacy, Ibn Rochd University Hospital Center, Hassan II University, Casablanca, Morocco
Khadija Kamal Department of General Surgery, Faculty of Medicine and Pharmacy, Ibn Rochd University Hospital Center, Hassan II University, Casablanca, Morocco
Mounir Bouali Department of General Surgery, Faculty of Medicine and Pharmacy, Ibn Rochd University Hospital Center, Hassan II University, Casablanca, Morocco
Abdelilah El Bakouri Department of General Surgery, Faculty of Medicine and Pharmacy, Ibn Rochd University Hospital Center, Hassan II University, Casablanca, Morocco
Khalid El Hattabi Department of General Surgery, Faculty of Medicine and Pharmacy, Ibn Rochd University Hospital Center, Hassan II University, Casablanca, Morocco

DOI:

https://doi.org/10.58372/2835-6276.1398

Keywords:

sigmoid volvulus, postpartum, cesarean section, bowel obstruction, Hartmann procedure, stercoral peritonitis

Abstract

Sigmoid volvulus during pregnancy and the postpartum period is a rare but serious cause of acute intestinal obstruction [1]. Its diagnosis remains challenging because symptoms may mimic common gastrointestinal manifestations occurring during the postpartum period, leading to delayed diagnosis and increasing the risk of bowel ischemia, necrosis, and peritonitis [2,4].

We report the case of a 34-year-old woman with a history of two cesarean deliveries, the most recent performed 21 days prior to admission. She presented with a 6-day history of bowel obstruction characterized by abdominal pain, constipation with absence of stool and flatus, and recurrent bilious vomiting.

Physical examination revealed marked abdominal distension associated with diffuse tympany. Abdominopelvic computed tomography demonstrated severe colonic distension upstream from a transition point associated with a characteristic whirl sign suggestive of sigmoid volvulus.

Emergency exploratory laparotomy revealed a mesenterico-axial sigmoid volvulus complicated by extensive colonic necrosis extending to the rectosigmoid junction, associated with stercoral peritonitis. Sigmoid resection with end colostomy according to the Hartmann procedure was performed.

Postpartum sigmoid volvulus remains an uncommon surgical emergency whose prognosis mainly depends on early diagnosis and prompt surgical management.

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