After Normal Childbirth, Woman Develops Rare Intestinal Twist: Case Sheds Light on Postpartum Risks

Volvulus, the twisting of a part of the intestine leading to obstruction, is a rare but recognized condition during pregnancy and the postpartum period. The physiological and anatomical changes that occur during and after pregnancy can increase the risk of such gastrointestinal complications. However, cases of transverse colon volvulus following a normal delivery are exceptionally uncommon.

The patient, in her first pregnancy, was diagnosed with gestational diabetes but managed her blood sugar well through diet and exercise. She had no history of abdominal surgery or chronic illness. At full term, she delivered a healthy baby girl without any complications. However, about 20 hours after delivery, she began experiencing abdominal discomfort, which escalated rapidly to severe pain and vomiting.

Initial physical examination revealed abdominal distension and tenderness. Imaging, including an abdominal ultrasound and CT scan, showed signs of intestinal swelling, twisted mesenteric vessels, and free fluid in the abdominal cavity. Laboratory tests pointed to inflammation, with elevated white blood cell counts and C-reactive protein levels.

A multidisciplinary team promptly diagnosed an intestinal volvulus and took the patient for emergency surgery. During the laparotomy, approximately 1500 mL of hemorrhagic fluid was drained. The transverse colon was found twisted nearly 360 degrees, with severe dilation but no necrosis. The volvulus was corrected without bowel resection, and the colon was anchored to prevent recurrence. A double-lumen transcolon stomy was created to manage intestinal drainage.

Postoperatively, the patient responded well. Inflammatory markers reduced significantly, and her condition stabilized. She was discharged in good health 16 days later. Four months after the initial surgery, a follow-up operation was conducted to close the colostomy and resect the affected segment of the colon with successful outcomes.

This case highlights the importance of early recognition and rapid surgical intervention in managing volvulus. The absence of specific symptoms and the overlap with common post-delivery discomfort often delay diagnosis.

"Physicians should maintain a high index of suspicion when postpartum women present with persistent or worsening abdominal pain. Prompt imaging and surgical consultation are critical to preventing serious complications and ensuring maternal safety," Sipei Nie, Department of Gynecology and Obstetrics, Affiliated Jiangning Hospital of Nanjing Medical University, Nanjing, Jiangsu, China, and colleagues concluded.

Reference:

Xu, Y., Zhu, Q., Zhang, C. et al. Transverse colon volvulus following normal delivery: report of a rare case and review of the world literature. BMC Pregnancy Childbirth 25, 436 (2025). https://doi.org/10.1186/s12884-025-07559-3