6 g/dL and platelets were 183 K/æL. The electrolytes and liver function test were normal. Thorax and cardio examinations were within normal. Abdominal x-ray showed severely distended bowel loops with multiple air fluid levels XAV-939 in vivo with no air seen in the rectum (Figure 1). Figure 1 X-ray examination showing the enormous dilatation and complete occlusion of the sigmoid. Based on the patient’s
presentation and examination, a diagnosis of intestinal obstruction was reached (sigmoid volvulus was highly suspected). A nasogastric tube (NGT) and Foley catheter were inserted. The gastroenterology team was consulted and it was decided to take the patient for emergency sigmoidoscopy. This revealed a sigmoid volvulus that was derotated and deflated. The scope was passed until the splenic flexure. A 20 French rectal tube was inserted with no immediate complications. The patient was transferred to the high-dependency unit for close monitoring. On subsequent assessment, she was not in pain, with resolution of the abdominal distension and passage of flatus. She was afebrile, with a pulse rate of 90 Kinase Inhibitor Library research buy and blood pressure of 120/70 mmHg. An abdominal x-ray the day after showed no distended bowel loops or fluid levels. The NGT was removed. She was started on fluids until
she could tolerate a full diet. The rectal tube was removed 2 days after the procedure and the patient was passing normal peristalsis. She was shifted back to the ward and kept for 2 more days for observation of fetal well-being, after which she was discharged for follow-up in the surgical and gynecology outpatients’ departments. Later she presented to gynecology for an elective cesarean section. During surgery a hugely distended sigmoid colon was found. Preoperative colonic detorsion was Urease done and elective sigmoidectomy planned (Figure 2). Figure 2 Dilatation of the sigmoid during the cesarean section delivery. Literature review methodology A literature search was performed using MEDLINE (PubMed), Google Selleckchem CP-690550 Scholar and The Cochrane Library, and articles from January 1900 until June 2013, edited in Italian, English and French, were analyzed.
The keywords used were: “sigmoid volvulus,” “pregnancy”. These keywords were added alone or in combination using the Boolean operator “AND”. Only patients with sigmoid volvulus in pregnancy were considered for the review. Irrelevant articles evident from the title and abstract were excluded. Relevant articles referenced in these publications were obtained and the “related article” function was used to widen the results. The search initially yielded 976 articles (Figure 3). After screening titles, 954 articles were excluded because they were not related to sigmoid volvulus in pregnancy. A total of 22 articles were found for the present study [1–4, 6–23] and a total of 95 patients were analyzed. Figure 3 Flowchart describing the selection of studies included in this article.