Volvulus, gangrene and perforation of transverse colon in an antepartum eclamptic pregnant patient post caesarean: a case report
Keywords:Outcome, Pregnancy, Transverse colon volvulus
Transverse colon volvulus leading to gangrene and perforation is an extremely uncommon acute surgical complication in pregnancy and puerperium, with a very high rate of mortality and morbidity. Surgical resection is the only treatment. Authors present a case of a 20 years. old women, with antepartum eclampsia, who underwent caesarean section for fetal distress. She complained of abdominal pain from second post-operative day. The pain increased in severity and on the third postoperative day, she developed sudden abdominal distention and appeared pale. Ultrasound revealed free intraperitoneal fluid suggestive of hemoperitoneum. An emergency laparotomy was performed. There was about a litre of blood in the peritoneal cavity with clots. The caesarean incision site, uterus adnexa and broad ligaments were all intact. On further exploration, volvulus of the transverse colon was seen along with gangrene and perforation of the middle part of transverse colon. Resection of the gangrenous part was done with closure of the distal loop. Proximal loop was brought out as colostomy. The patient had an uneventful postoperative course thereafter and was discharged on regular diet on 12th postoperative day. Volvulus of transverse colon leading to gangrene is rare in pregnancy and puerperium, but must form part of clinician’s differential diagnosis when encountering a patient with persistent abdominal pain and bowel distention. Early diagnosis and timely surgical intervention could significantly improve the outcome of this catastrophic condition.
Coughlan BM, O’Herlihy C. Acute intestinal obstruction during pregnancy. J R Coll Surg. 1978;23:175-7.
Perdue PW, Johnson HW, Stafford PW. Intestinal obstruction complicating pregnancy. Am J Surg. 1992;164:384-8.
Kallio K. Uber volvulus coli transversii. Acta Chir Scand. 1932;70:39-58.
Iwamoto I, Miwa K, Fujino T, Douchi T. Perforated colon volvulus coiling around the uterus in a pregnant woman with a history of severe constipation. J Obstet Gynaecol Res. 2007;33:731-3.
Harer WB, Harer WB. Volvulus complicating pregnancy and puerperium; report of three cases and review of literature. Obstet Gynecol. 1958;12:399-406.
Sascha Dua R, Rothnie ND, Gray EA. Sigmoid volvulus in the Puerperium. Int J Gynaecol Obstet. 2007;97:195.
Kolusari A, Kurdoglu M, Adali E, Yildizhan R, Sahin HG, Kotan C. Sigmoid volvulus in pregnancy and puerperium: a case series. Cases J. 2009;2(1):1-3.
Damore LJ II, Damore TH, Longo WE, Miller TA. Congenital intestinal malrotation causing gestational intestinal obstruction. A case report. J Repord Med. 1997;42:805-8.
Perdue PW, Johnson HW Jr, Stafford PW. Intestinal obstruction complicating pregnancy. Am J Surg. 1992;164:384-8.
Zinkin LD, Katz LD, Rosin JD. Volvulus of the transverse colon: report of case and review of the literature. Dis Colon Rectum. 1979;22:492-6.
Lau K, Miller B, Schache D, Cohen J. A study of large-bowel volvulus in urban Australia. Can J Surg. 2006;49:203-7.
Sparks D, Murtaza Y, Chase D, Thomas D. Ischaemic volvulus of the transverse colon: a case report and review of the literature. Cases J. 2008;1:174.
Rahbour G, Ayantunde A, Ullah M, Arshad S, Kerwat R. Transverse colon volvulus in a 15 year old boy and the review of the literature. World J Emerg Surg. 2010;5:19.
Ciraldo A, Thomas D, Schmidt S. A case report: Transverse colon volvulus associated with Chilaiditis syndrome. Internet J Radiol. 2000;1:1.
Eisenstat T, Raneri A, Mason G. Volvulus of the transverse colon. Am J Surg. 1977;134:396-9.
Javors B, Sorkin N, Flint G: Transverse colon volvulus: a case report. Am J Gastroenterol. 1986;81:708-10.
Fishman EK, Goldman SM, Patt PG, Berlanstein B, Bohlman ME. Transverse colon volvulus: diagnosis and treatment. South Med J. 1983;76:185-9.