Sigmoid Volvulus Complicating the Postpartum Period After Cesarean Section: A Rare Case Report

Résumé

Sigmoid volvulus during pregnancy and the postpartum period is a rare but serious cause of acute intestinal obstruction [1]. Its diagnosis remains challenging because symptoms may mimic common gastrointestinal manifestations occurring during the postpartum period, leading to delayed diagnosis and increasing the risk of bowel ischemia, necrosis, and peritonitis [2,4]. We report the case of a 34-year-old woman with a history of two cesarean deliveries, the most recent performed 21 days prior to admission. She presented with a 6-day history of bowel obstruction characterized by abdominal pain, constipation with absence of stool and flatus, and recurrent bilious vomiting. Physical examination revealed marked abdominal distension associated with diffuse tympany. Abdominopelvic computed tomography demonstrated severe colonic distension upstream from a transition point associated with a characteristic whirl sign suggestive of sigmoid volvulus. Emergency exploratory laparotomy revealed a mesenterico-axial sigmoid volvulus complicated by extensive colonic necrosis extending to the rectosigmoid junction, associated with stercoral peritonitis. Sigmoid resection with end colostomy according to the Hartmann procedure was performed. Postpartum sigmoid volvulus remains an uncommon surgical emergency whose prognosis mainly depends on early diagnosis and prompt surgical management.

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