Sigmoid Volvulus in a Pregnant Woman: A Rare Case Report of Intestinal Obstruction During Pregnancy That Requires Prompt Surgical Intervention.

Background and Aims: Sigmoid volvulus (SV) is a common cause of large-bowel obstruction in elderly patients but represents a rare and potentially life-threatening cause of intestinal obstruction during pregnancy. Physiological and anatomical changes in pregnancy may delay diagnosis, increasing maternal and fetal risks. This case report aims to highlight the diagnostic and therapeutic challenges of SV in pregnancy. Methods: We report the case of a 32-year-old pregnant woman at 27 weeks and 4 days of gestation who presented with acute abdominal pain, nausea, and constipation. Clinical evaluation, laboratory testing, abdominal ultrasound, magnetic resonance imaging (MRI), and colonoscopy were used to establish the diagnosis. Results: SV was confirmed, and endoscopic detorsion was attempted twice as first-line management but was unsuccessful. Given persistent obstruction and symptom severity, surgical intervention was undertaken. The patient underwent sigmoid colon resection with colostomy (Hartmann procedure). Both maternal and fetal postoperative courses were favorable, and the pregnancy was successfully prolonged to term. Conclusion: Although rare, SV should be considered in pregnant women presenting with symptoms of intestinal obstruction. Early diagnosis, appropriate imaging, and a multidisciplinary approach are essential. Endoscopic detorsion remains the first-line treatment when feasible, while timely surgical management is essential in cases of failed decompression to optimize maternal and fetal outcomes.