Systematic Reviews
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jun 27, 2025; 17(6): 107151
Published online Jun 27, 2025. doi: 10.4240/wjgs.v17.i6.107151
Sigmoid and cecal volvulus in pregnancy and puerperium: A systematic review
Goran Augustin, Zrinka Hrgović, Ante Tavra, Bojana Jovović, Leon Serdarević, Jure Krstulović
Goran Augustin, Department of Surgery, University Hospital Centre Zagreb, Zagreb 10000, Croatia
Zrinka Hrgović, Ante Tavra, Jure Krstulović, University of Split School of Medicine, Split 21000, Croatia
Bojana Jovović, Leon Serdarević, Institute of Emergency Medicine of Split-Dalmatia County, Croatian Institute of Emergency Medicine, Split 21000, Croatia
Jure Krstulović, Department of Surgery, University Hospital of Split, Split 21000, Croatia
Author contributions: Augustin G and Krstulović J contributed to conception, design of the work and the acquisition; Jovović B and Serdarević L contributed to analysis and interpretation of data for the work; Augustin G, Tavra A, and Hrgović Z contributed to drafting the work and reviewing it critically for important intellectual content; Hrgović Z, Tavra A, Krstulović J, Jovović B, Serdarević L, and Augustin G contributed to final approval of the version to be published.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Goran Augustin, MD, PhD, Academic Editor, Department of Surgery, University Hospital Centre Zagreb, Kišpatićeva 12, Zagreb 10000, Croatia. augustin.goran@gmail.com
Received: March 20, 2025
Revised: April 1, 2025
Accepted: April 24, 2025
Published online: June 27, 2025
Processing time: 72 Days and 3.1 Hours
Abstract
BACKGROUND

Cecal and sigmoid volvulus during pregnancy are extremely rare. Symptoms of intestinal obstruction in pregnancy make accurate clinical diagnosis challenging.

AIM

To identify predictive factors for early diagnosis and successful treatment and an association between the diagnosis and maternal/neonatal outcomes.

METHODS

A systematic review of human studies (PubMed, PubMedCentral, Google Scholar) up to October 2024 was conducted per PRISMA guidelines. Data on demographics, clinical features, diagnostics, treatment, and outcomes were analyzed.

RESULTS

Antepartum and postpartum volvulus occurred in 75.5% and 24.5% of cases, respectively, most commonly in the third trimester (70.3%). Nausea was less frequent and obstipation was more common in sigmoid volvulus (P = 0.0004). Endoscopic detorsion was successful in 23.9% of sigmoid cases, with a mean gestational age of 33.5 ± 3.5 weeks. Maternal mortality was 12.5% for cecal and 5.5% for sigmoid volvulus (P = 0.103). While maternal mortality was unaffected by the timing of delivery relative to surgery, fetal mortality was significantly higher when the interval was < 24 hours (52.9% vs 10.4%, P < 0.001). Both maternal and fetal mortality declined over time.

CONCLUSION

Constipation was a risk factor for sigmoid volvulus and prior open appendectomy for cecal volvulus. Endoscopy was more often used in sigmoid cases. Gestational age and maternal age did not affect fetal outcomes. Earlier imaging and appropriate surgery were linked to lower mortality. Delay > 24 hours between intervention and delivery increased fetal, but not maternal mortality. Successful endoscopic detorsion eliminated maternal mortality and significantly lowered fetal mortality.

Keywords: Sigmoid volvulus; Cecal volvulus; Pregnancy; Puerperium; Outcomes; Systematic review

Core Tip: Cecal and sigmoid volvulus in pregnancy and puerperium are extremely rare. Constipation is a risk factor for sigmoid volvulus and open appendectomy for cecal volvulus. Endoscopic detorsion was successful through all trimesters and only performed for sigmoid volvulus. Neither gestational week nor maternal age influenced fetal outcome. Maternal and fetal mortality depended on the diagnostic imaging and the type of surgical procedure. Successful endoscopic detorsion eliminated maternal mortality and significantly lowered fetal mortality. Over the course of the century, maternal and fetal mortality have declined continuously, with maternal mortality at a steeper rate.