Early Puerperium Gangrenous Sigmoid Volvulus: Case Report

Abstract

Sigmoid volvulus is the third most common cause of colonic obstruction. Men and women are not affected equally and some cases have been reported to occur during pregnancy [1, 2]. The current literatures are still devoid of the cases that occur soon after delivery in the early puerperal period. We present a 37 years’ old female who was brought to St. Francis Regional Referral Hospital (SFRRH) as a referral from nearby health Centre with absolute intestinal obstruction that had an acute onset just one day after her non-eventful spontaneous vertex delivery, she was brought to us on the second day course. On examination she was ill looking with a nasogastric tube insitu that was draining bilious fluid. Her abdomen was grossly distended, hyper-tympanic with an empty rectum on digital rectal examination. She had hypokalemia that was corrected prior surgery and the plane abdominal x-ray showed a gaseous distended colon with a typical coffee bean sign. Intraoperatively a mega distended and a gangrenous sigmoid colon was laying on the rest of the visceral – twisting in a 3600 clockwise direction. A whole of the sigmoid colon was gangrenous of which a total sigmoidectomy was done followed by closure of the rectal stamp and its attachment to the anterior abdominal wall. The lateral to medial descending colon mobilization was done that culminated into placement of the end colostomy. Though noticed and reported during pregnancy, an attention should also be paid to those patients presenting with such obstruction soon after delivery on the early puerperium, this will facilitate early diagnosis and intervention so as to prevent undesirable complications as in the case of this patient.