Sigmoid and cecal volvulus in pregnancy and puerperium: A systematic review

Cecal and sigmoid volvulus during pregnancy are extremely rare. Symptoms of intestinal obstruction in pregnancy make accurate clinical diagnosis challenging.

To identify predictive factors for early diagnosis and successful treatment and an association between the diagnosis and maternal/neonatal outcomes.

A systematic review of human studies (PubMed, PubMedCentral, Google Scholar) up to October 2024 was conducted per PRISMA guidelines. Data on demographics, clinical features, diagnostics, treatment, and outcomes were analyzed.

Antepartum and postpartum volvulus occurred in 75.5% and 24.5% of cases, respectively, most commonly in the third trimester (70.3%). Nausea was less frequent and obstipation was more common in sigmoid volvulus (P = 0.0004). Endoscopic detorsion was successful in 23.9% of sigmoid cases, with a mean gestational age of 33.5 ± 3.5 weeks. Maternal mortality was 12.5% for cecal and 5.5% for sigmoid volvulus (P = 0.103). While maternal mortality was unaffected by the timing of delivery relative to surgery, fetal mortality was significantly higher when the interval was < 24 hours (52.9% vs 10.4%, P < 0.001). Both maternal and fetal mortality declined over time.

Constipation was a risk factor for sigmoid volvulus and prior open appendectomy for cecal volvulus. Endoscopy was more often used in sigmoid cases. Gestational age and maternal age did not affect fetal outcomes. Earlier imaging and appropriate surgery were linked to lower mortality. Delay > 24 hours between intervention and delivery increased fetal, but not maternal mortality. Successful endoscopic detorsion eliminated maternal mortality and significantly lowered fetal mortality.