Cesarean section is suggested by some authors also in case of fetal death. In such cases, this procedure must be done first and special care taken to avoid contamination of the peritoneum. Indeed, this can itself be a cause of mortality due to a consequent severe puerperal infection [13]. A delay in diagnosis and surgical intervention over 48 h can have a significant impact on the ultimate outcome of the mother and fetus [2]. The management of sigmoid volvulus in pregnancy begins with aggressive hydration and proximal bowel decompression [13]. In the absence of mucosal

ischemia, sigmoidoscopic detorsion and rectal tube insertion is possible. Apoptosis inhibitor In recurrent cases, elective sigmoidectomy can be safely performed in the second trimester

[20]. Otherwise, surgery can be postponed until after delivery. In cases of bowel gangrene or perforation, prompt surgical intervention through a midline laparotomy is essential. Thorough peritoneal Selleck PD-1/PD-L1 inhibitor lavage of the resection of the necrotic bowel segments is mandatory. This is followed by either primary anastomosis or stoma formation (Hartman’s procedure) [28]. The prognosis of sigmoid volvulus in pregnancy is poor. In the last century, the maternal mortality rate was 21–60% and fetal mortality rate was 50% [5]. In recent decades, the maternal mortality has decreased to 6–12% and fetal mortality to 20–26% [29]. The major causes of maternal mortality are toxic and/or hypovolemic shock, whereas impairment of placental blood flow due to increased intraabdominal pressure affects fetal mortality [30]. Conclusion Sigmoid volvulus is a rare and potentially fatal condition in pregnancy that requires a multidisciplinary approach with general surgeons, obstetricians, and neonatologists. Prompt diagnosis is critical for early management, to minimize fetal and maternal morbidity and mortality. Abdominal pain may be the only findings, and sigmoidoscopic detorsion or surgical resection are the treatment options, depending on bowel viability. Consent Written informed

consent was obtained from the patient for publication of this Case report and any accompanying images. References 1. Lord SA, Boswell WC, Hungerpiller JC: Sigmoid volvulus in pregnancy. Am Surg Unoprostone 1996, 62:380–382.PubMed 2. Harer WB Jr, Harer WB Sr: Volvulus complicating pregnancy and puerperium; report of three cases and review of literature. Obstet Gynecol 1958, 12:399–406.PubMed 3. Nascimento EFR, Chechter M, Fonte FP, Puls N, Valenciano JS, Filho CLPF, Nonose R, Bonassa CEG, Martinez CAR: Volvulus of the sigmoid colon during pregnancy: a case report. Case Rep Obstet Gynecol 2012. doi:10.1155/2012/641093 4. 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, 33:731–733. 10.1111/j.1447-0756.2007.00641.xPubMedCrossRef 5. Perdue PW, Johnson HW Jr, Stafford PW: Intestinal obstruction complicating pregnancy.