UNUSUAL PRESENTATION OF ACUTE INTESTINAL OBSTRUCTION DUE TO TRANSVERSE COLON VOLVULUS IN LATE PREGNANCY

Abstract

Transverse colon volvulus is the rarest type of colonic volvulus, with a higher morbidity and mortality rate. In pregnancy, intestinal obstruction due to transverse colon volvulus is rare and seldom reported, and its timely diagnosis can be difficult. We report an unusual case of transverse colon volvulus in a young female at late-term pregnancy. A 28-years-old, pregnant woman, gravida 2, para 1, at 34 weeks of gestation, presented with progressive abdominal pain and distention, commencing about 12 hours prior to admission, associated with vomiting and obstipation. Vital signs were stable. However, the abdomen was asymmetrically hugely distended. The initial abdominal ultrasound showed a single viable intrauterine fetus and dilated loops of bowels. As fetal distress progressed throughout the admission, a laparotomy was performed, which revealed an unexpected transverse colonic volvulus. Resection of the twisted segment and primary anastomosis were performed, followed by a cesarean section to deliver the baby. The mother made a satisfactory recovery. Although this patient’s preoperative clinical findings suggested colonic obstruction, the diagnosis of transverse colonic volvulus was only made intraoperatively and has seldom been previously described. Chronic constipation, the enlarging uterus, and the anatomical redundancy of the transverse colon may have been contributing factors. Transverse colon volvulus in late pregnancy is uncommon. Early diagnosis and prompt surgical intervention can significantly minimize maternal and fetal mortality.