not-yet-known not-yet-known not-yet-known unknown A case report of a pregnancy complicated by sigmoid volvulus in the extreme preterm gestational age Authors list: Corresponding Author: Naghmeh Kian (School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran. [email protected]) Co-author: Atefeh Moridi (Preventive Gynecology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran. [email protected]) Key Clinical Message Intestinal obstruction including sigmoid volvulus is an unusual incident during pregnancy which might be mismanaged due to the lack of clinical suspicion or delayed action. This study provides useful information in regards to timely diagnosis and practical methods of management in order to prevent gestational morbidity and mortality. 0.1 Abstract Intestinal obstruction is a rare but life-threatening incidence in pregnancy. Diagnosis can be challenging for clinicians as the symptoms might be approached as other common obstetric complications. Performing radiological and abdominal surgery are also areas of great concern in this field; since radiologic studies inevitably expose the fetus to radiation and the treatment options mostly involve surgery that is worrisome during gestation. The maternal and fetal outcomes are dependent on timely diagnosis and management; as intestinal perforation, necrosis and peritonitis can happen and lead to fetal or maternal mortality or morbidity. In this study, we present a challenging case of a 36-year-old pregnant women with severe abdominal pain and distension that emergently underwent surgery after the diagnosis of sigmoid volvulus without the gestation being discontinued. To our knowledge, our study presents one of the rarest cases of intestinal obstruction during pregnancy that was managed surgically without pregnancy termination. Further we will discuss intestinal obstruction in pregnancy based the current literature. Keywords: intestinal obstruction, volvulus, pregnancy, OB & GYN 0.2 Introduction Obstruction of the intestinal lumen is uncommon during pregnancy and is reported to happen from one in 1500 to one in 66,431 pregnancies (1). Since first described by Dr. Braun in 1885, Sigmoid volvulus is known as a common type of intestinal obstruction and is reported in 44% of pregnant cases with intestinal obstruction (2, 3). In the first, second, and third trimesters, sigmoid volvulus reportedly happened in 6%, 19%, and 54% of cases, and in 21% in the postpartum period (4). The most common causes of intestinal obstruction are adhesion, volvulus, intussusception, carcinoma, hernia and appendicitis (4). The clinical presentation during pregnancy might be obscure due to the physiological changes of maternal body, thus making quick diagnosis and timely management a challenge (5). With that being said, intestinal obstruction is a diagnosis that can be made when high amount of clinical suspicion is present or otherwise it will be missed and might lead to bowel ischemia, necrosis, perforation, peritonitis, sepsis, preterm labor and both fetal and maternal death (6). The decision to perform a radiological study (e.g. a CT scan in our case) is often not favorable during pregnancy due to the concerns for fetal radiation exposure. However, an abdominal contrast-enhanced CT scan which is available in most centers including ours, provides a definitive diagnosis in a short amount of time and determines the exact site of obstruction for further intervention (7, 8). The type of intervention and the decision to finish the pregnancy is dependent on the gestational age, clinical scenario, the extent of bowl ischemia and the viability of the fetus. In this study, we present a 36-year-old multiparous women in her 24th weeks’ gestation who was diagnosed with sigmoid volvulus after an oral contrast enhanced- abdominal CT scan and underwent a Hartman procedure emergently without the pregnancy being discontinued. 0.3 Case history/examination Our case was a 36-year-old multiparous women in her 24th weeks’ gestation who came to the emergency room of Mahdieh OB&GYN hospital, complaining of abdominal pain. The patient had an uneventful pregnancy until three days ago when she started feeling an abdominal pain and pressure which increased in severity day by day. She was unable to defecate and pass gas in the last three days. She has had visited several doctors for her constipation and received plenty of bisacodyl prescriptions which did not change her condition. She had given birth to four healthy kids and had no history of abortion or fetal death. The first two deliveries were performed vaginally but the last two children were delivered by cesarean section due to breech position and repeated cesarean, respectfully. Her last pregnancy dated back to 6 years ago. The patient did not receive any prenatal care during this pregnancy. Except for bisacodyl suppositories in the last three days, the patient was taking no medications other than routine supplements. She declared no past medical condition and no history of surgery other than the cesarean sections. 0.1 Abstract