1. Gangrenous Sigmoid Volvulus Complicating Pregnancy : Report Of A Case HAMRI.A, NARJIS.Y, RABBANI.K, LOUZI.A, BENELKHAIAT.R, FINECH.B SERVICE DE CHIRURGIE DIGESTIVE MARRAKECH CONGRÈS NATIONAL DE CHIRURGIE

2. Background  Sigmoid volvulus is a rare and serious cause of intestinal obstruction during pregnancy, with incidence between 1/1500 and 1/66000 deliveries, associated with high rates of maternal and fetal mortality. Especially if not recognized and treated precociously  The gangrene results due to delay caused by conservative trial for sake of pregnancy, avoidance of radiology based investigations, and rarity of the condition and the masking of clinical picture by pregnancy  Perforation, peritonitis and sepsis can be the maternal complications if intervention is not done early in the course of the disease. The fetal complications include preterm delivery, intrauterine death and neonatal sepsis CONGRÈS NATIONAL DE CHIRURGIE Aim Show the seriousness consequence of a late diagnosis and treatment

3. Case Report  A 29 year-old lady, primagravida,pregnant for 39 weeks and with one week history of abdominal pain, nausea, vominting and constipation. She had no previous significant medical or surgical problems.  On examination she was febrile (temperature of 38,5°)and blood 100/70mmhg, pulse 98bpm and her fundal height corresponded to 39 weeks of gestation. The cervix was closed.  The abdomen showed asymmetric distention more prominent on left flanks. Bowel sounds were absent  ultrasound exam, RCF showed fetal distress on bradycardia. Radiograph showed sigmoid volvulus.  Routine laboratory examination results were normal except for an elevated white blood cell count of 20 × 103/µL. CONGRÈS NATIONAL DE CHIRURGIE

4. Case Report CONGRÈS NATIONAL DE CHIRURGIE  Abdominal radiographs revealed a dilated colon in the upper abdomen and air fluid levels. The colon showed significant dilation with the image in “horseshoe” suggesting the presence of Sigmoid Volvulus. There were no signs of pneumoperitoneum. Chest radiography showed a significant elevation of the diaphragm  At emergency, after resuscitation preparations, She underwent concomitant caesarean section and laparotomy for intestinal obstruction, under general anesthesia. Intra-operatively, the sigmoid colon was extensively dilated and gangrenous. The ischemic colon was resected and a Hartmann’s procedure was performed. Male child was delivered and admitted to neonatal intensive care, he was declared dead a few hours later.  The post operative course was uneventful and the patient was discharged home on the 11th post-operative day. Colostomy was closed after four months later and colorectal anastomosis was done

5. Punch Line  sigmoid volvulus diagnosis in pregnancy is a challenge, but a delay in diagnosis increases the rates of feto-maternal mortality. A high incidence of clinical suspicion and timely surgical intervention are the key to a favorable outcome  Diagnosis requires a high index of suspicion in a patient who presents with complaints of abdominal pain and evidence of bowel obstruction.  The aim of surgical treatment is to remove the obstruction. the choice of intestinal resection by elimination of the risk of recurrence and reduction of morbidity and mortality  Delay in diagnosis and treatment beyond 48 hours results in colonic necrosis and increased fetal and maternal morbidity and mortality. Prompt intervention is necessary to minimize these complications and achieve a definitive cure CONGRÈS NATIONAL DE CHIRURGIE