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

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.