EP216 - Case Report: Sigmoid Volvulus in a Pregnant Patient with Sensorineural Hearing Loss

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Purpose/Background: Sigmoid volvulus during pregnancy is a rare but critical condition that demands a high level of clinical awareness. If not diagnosed early, it can lead to severe maternal and fetal complications, such as intestinal ischemia or perforation. We report a case involving a 23-week pregnant 37-year-old Hispanic female with bilateral sensorineural hearing loss (SNHL) who presented with this condition.

Methods/Interventions: The patient was a 37-year-old Gravida 3 Para 2 female at 22 weeks and 3 days of gestation, with SNHL who presented with 4 days of intermittent abdominal pain, worse with fetal movement and unresponsive to acetaminophen. Associated symptoms included nausea, vomiting, decreased flatus, and loose, scant bowel movements. Vital signs were normal; however, physical examination revealed moderate discomfort and a distended, tympanic abdomen. Laboratory tests indicated leukocytosis (12.1). CTAP showed sigmoid volvulus. The gastroenterology team successfully performed endoscopic detorsion.
After discussion with the maternal fetal medicine team and the patient, it was determined safest to undergo open sigmoid resection prior to fetal viability to facilitate resection while the uterus was still relatively small and to alleviate her risk of recurrent volvulus. She remained in the hospital until surgery without recurrence of symptoms. Surgical findings revealed a significantly dilated sigmoid colon, partially volvulized, with congenital mesenteric adhesions contributing to the volvulus. All bowel was viable. The patient underwent lysis of adhesions and sigmoid resection with an end-to-side primary colo-colonic anastomosis. A 19Fr channel drain was placed in the pelvis. Fetal heart tones were monitored perioperatively and remained normal throughout.

Results/Outcomes: Postoperatively, the patient showed no signs of complications for either maternal or fetal health. She was discharged four days after surgery, having regained bowel function and tolerating a regular diet. At her two-week follow-up, she reported adequate recovery and mild incisional pain.

Conclusion/Discussion: Timely sigmoid resection is critical to prevent recurrent volvulus and its complications such as ischemia and perforation. This case also highlights the key role of effective multidisciplinary communication in this pregnant patient with SNHL in ensuring appropriate diagnosis and treatment for patients with sensory impairments, facilitating optimal outcomes for both mother and fetus.