Furthermore, the patient may present with fever, dehydration, absence of bowel sound and leukocytosis. These clinical signs might easily be detected in a non-pregnant woman, but are common in pregnancy [16]. The delay in diagnosis of sigmoid volvulus may lead to bowel infarction and necrosis with hypovolemia, electrolyte disturbances, renal failure, metabolic acidosis, septic shock and multiple organ failure with a significant devastating CDK inhibitor drugs outcome for the mother and the fetus. Maternal mortality for sigmoid volvulus has been reported to be 5% if the bowel

is viable, but rises to over 50% if perforation has occurred [13]. Fetal mortality in sigmoid volvulus is approximately 30%. The fetal death could be caused by reduction in placental blood flow in hypovolemia, or by reduction of the abdominal and pelvic blood flow due to increased intraabdominal pressure as a result of massive GS-7977 mw sigmoid dilatation [10]. Diagnosis of intestinal obstruction in

pregnancy is difficult, as the classical symptoms of abdominal distension, nausea and vomiting are common in uncomplicated pregnancies [13]. The diagnosis should be suspected when a pregnant woman presents with a clinical symptom of abdominal pain, distention and absolute constipation [5]. The leukocytosis can be a consistent sign but in the first phase of the disease can be normal or slightly elevated [15]. Furthermore, the white cell count is normally elevated in pregnancy [22]. The use of radiological tools can be useful to establish the diagnosis, but many clinicians are reluctant to use them for fear of fetal complications. Radiation exposure may lead to chromosomal selleck chemical abnormalities, neurologic Carbachol mutations and increased risk of hematologic malignancies [26]. However, even with plain computed tomography (CT) scans of the abdomen, the radiation dose is still thought to be within the safe exposure limit (5–10 rads) [27]. Still, many authors believe it is best avoided because of

the radiation risks to the fetus. In contrast, abdominal and obstetric ultrasonography may eliminate the radiologic risk and provide information about the fetus [22]. The management of sigmoid volvulus in pregnancy requires a multidisciplinary approach with general surgeons, obstetricians, and neonatologists [16]. The patient should be treated with fluids, electrolyte balance correction, prophylactic antibiotics, and nasogastric decompression. Tocolytics should be administered if uterine irritability is observed, and steroids initiated to promote fetal lung maturity [22]. Obstetric intervention should strictly depend on the condition of the fetus. The integrity of the uterus has to be preserved in the case of a vital fetus [19]. In cases of fetal maturity, a vaginal labor can be induced if the condition of the mother and fetus is stable [19].