Small bowel volvulus secondary to torsion of a mature cystic teratoma in the first trimester of pregnancy: A case report

TL;DR

A rare case of small bowel volvulus caused by ovarian cyst torsion occurred in a pregnant woman during her first trimester, requiring emergency surgery and resulting in a healthy baby.

Contribution

This is the first documented case of small bowel volvulus due to ovarian cyst torsion in the first trimester of pregnancy.

Findings

The patient required emergency surgery to remove gangrenous ovarian tissue and a segment of small bowel.

The patient delivered a healthy infant six months later with no complications.

Early surgical intervention is critical to reduce mortality in such cases.

Abstract

Small bowel volvulus is a rare but potentially life-threatening surgical emergency. Its occurrence in association with ovarian cyst torsion during pregnancy is exceedingly rare, with few cases reported. To the authors' best knowledge, this case represents the first documented instance occurring in the first trimester.

A 37-year-old woman (gravida 3, para 2) at 12 weeks +2 days of gestation was referred with a 16-h history of crampy abdominal pain, initially infraumbilical and later diffuse, accompanied by multiple episodes of vomiting, which progressed from ingested matter to bilious, and 12 h of progressive abdominal distension.

On presentation, she appeared acutely ill and in severe pain, with abdominal examination revealing generalized peritonitis. She was promptly started on intravenous antibiotics and fluid resuscitation, and an emergency laparotomy was performed. Intraoperatively, a torsioned adnexal mass, gangrenous right ovary, fallopian tube, and a segment of small bowel were identified and resected. The patient left the operating room with stable vital signs and was subsequently transferred to the ward, where she recovered well. Six months later, she delivered a healthy 3.5 kg female infant via repeat cesarean section, with no complications.

Although small bowel volvulus is rare, it must be considered in patients with intestinal obstruction. Delayed recognition can cause ischemia, necrosis, and perforation, so maintaining suspicion, performing timely investigations, and initiating early surgical intervention are essential to improve outcomes and reduce morbidity and mortality.

•Small bowel volvulus is a rare, life-threatening obstruction with high ischemic risk.•In early pregnancy, it is uncommon and often missed due to overlapping symptoms.•Primary volvulus is anatomical; secondary results from malrotation, tumors, or cysts.•CT findings help diagnosis, but peritonitis mandates urgent surgical intervention.•Early surgery reduces mortality, which is high in advanced gangrenous disease.

Small bowel volvulus is a rare, life-threatening obstruction with high ischemic risk.

In early pregnancy, it is uncommon and often missed due to overlapping symptoms.

Primary volvulus is anatomical; secondary results from malrotation, tumors, or cysts.

CT findings help diagnosis, but peritonitis mandates urgent surgical intervention.

Early surgery reduces mortality, which is high in advanced gangrenous disease.

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