Cecal Volvulus in Pregnancy, a Diagnostic Dilemma and Management: A Case Report and Literature Review

Abstract

Introduction

Colonic volvulus is an unusual cause of intestinal obstruction in pregnant women. Cecal volvulus, second only to sigmoid volvulus, accounts for 1–2% of all cases of intestinal obstruction. Due to its infrequent occurrence, only a few articles have documented its diagnosis and management among pregnant women, and we assume this to be the first reported case in Ethiopia, as per the authors’ knowledge.

Case Presentation

A 26-year-old Gravida 3, Para 2 mother who has had amenorrhea for the last five months presents with a complaint of upper abdominal cramps with associated vomiting, which is bilious, upper abdominal distension, and obstipation of five-hour duration. Her vital signs were in the normal range, and she had upper abdominal tenderness. Plain abdominal radiography suggested a cecal volvulus and exploratory laparotomy, a right hemicolectomy, and end-to-side ileotransverse colon anastomosis was performed. The postoperative course was uneventful.

Discussion

The cecal volvulus is an axial twist of the cecum, segment of the terminal ileum, and ascending colon along its mesentery, resulting in closed-loop obstruction with early vascular compromise and ischemia. It requires an anatomic prerequisite, which makes the cecum hypermobile, unlike the sigmoid volvulus. Diagnosis is challenging in pregnant women, as there are many differential diagnoses and a reluctance to request radiological imaging.

Conclusion

A high index of suspicion is of paramount importance whenever a pregnant woman comes with a complaint of persistent abdominal cramps and obstipation. Early diagnosis and management are crucial to improve patients’ outcome. Plain abdominal radiography is the safest option of imaging modality in low-resource areas where magnetic resonance imaging (MRI) is not available during pregnancy whenever intestinal obstruction is considered. Right hemicolectomy is the preferred surgical option.

Keywords:

• Cecal volvulus
• intestinal obstruction
• pregnancy
• right hemicolectomy

Abbreviations

SCARE, Surgical CAse Report; MRI, Magnetic Resonant Imaging.

Highlights

• Intestinal obstruction is one of the life threatening causes of acute abdomen in pregnancy.

• Cecal volvulus is a rare cause of intestinal obstruction.

• Pregnancy poses a particular risk factor for the cecal volvulus.

• Limited X-ray films are safe during pregnancy.

• Right hemicolectomy is considered best surgical option as it eliminates the recurrence rate.

Data Sharing Statement

All the generated data are included in this article.

Ethical Approval

No institutional review board approval was required.

Informed Consent for Publication

Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent form is available for review by the Editor-in-Chief of this journal upon request.

Acknowledgment

Mursal Ibrahim, MD, Obstetrics and Gynecology resident, Department of Obstetrics and Gynecology, Jigjiga University, Ethiopia: involved in evaluation and management of the patient.

Author Contributions

All authors contributed to the data analysis, drafting or revising the article, have agreed on the journal to which the article will be submitted, gave final approval or the version to be published, and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

Funding

This case report did not receive any specific grants from funding agencies in the public, commercial, or nonprofit sectors.