2 Figure 1: Plain abdominal radiograph with dilated colon. Figure 2: Surgical ﬁndings with gangrenous cecal volvulus. It has been postulated that uterine enlargement during pregnancy pushes up the redundant or abnormally mobile cecum out of the pelvis, which increases the chances of its axial rotation around a ﬁxed point. During puerperium a diﬀerent set of events occur; there is rapid reduction of intra-abdominal contents, which may alter the mechanical equilibrium of the bowel and mesenteric base leading to twisting of bowel segments [6]. Volvulus gives rise to twin sets of clinical ﬁndings due to two components, namely, mechanical obstruction and vascular compromise. Pregnancy, however, may obscure these signs due to enlarged gravid uterus displacing and shielding the abdominal viscera from clinical scrutiny and symptoms might be mistaken for common discomfort of pregnancy thus delaying the diagnosis. The diagnosis of acute abdomen is also delayed during puerperium, which, however, cannot be explained by large uterus obscuring the signs. Increased abdominal girth and diﬃculty of eliciting signs of peritonism due to lax abdominal wall have been suggested as explanations for failure to diagnose acute abdomen early in puerperium [7]. X-ray abdomen is highly sensitive (95%) investigation for diagnosis of cecal volvulus. A characteristic “coﬀee bean” Case Reports in Obstetrics and Gynecology deformity may be seen directed towards the left upper quad- rant as seen in our patient, which, however, was appreciated retrospectively. But dilated cecal loop may appear anywhere in the abdomen due to its abnormal mobility [8], and it has been suggested that volvulus should be suspected when there is a single grossly dilated loop of bowel on radiograph [9]. The therapeutic algorithm is the same for pregnant and non pregnant women. Surgical treatment of cecal volvulus con- sists of untwisting the bowel, decompressing the distended segments, removing the devitalized tissue, and preventing recurrence. The surgical techniques described for cecal volvulus are cecostomy, cecopexy, resection with ileostomy, and resection with primary anastomosis. Though a rare event, the incidence of intestinal obstruc- tion during pregnancy and puerperium is on the rise due to increasing rate of cesarean deliveries. Hence, an obstetrician is likely to come across a case of bowel obstruction with pregnancy or puerperium in his or her lifetime. Because of peculiar changes of pregnancy and puerperium the diagnosis is often delayed leading to life-threatening complications. We must ask ourselves: is the delay in diagnosis really inevitable? Cecal gangrene ensues in an average duration of 48–72 hours. A high index of suspicion, urgent X-ray in a patient of acute abdomen, followed by computerized tomography if required and laparotomy within golden time that is, 24 hours of onset may prevent gangrene and resultant perforation of the intestine. We believe that a heightened awareness amongst obstetricians regarding the possibility and knowledge of diagnostic tools and their immediate and liberal use, in particular radiograph, can and should prevent the delay in diagnosis. Conﬂict of Interests The authors hereby declare that they have no conﬂict of in- terests. References [1] P. W. Perdue, H. W. Johnson, and P. W. Staﬀord, “Intestinal obstruction complicating pregnancy,” American Journal of Surgery, vol. 164, no. 4, pp. 384–388, 1992. [2] L. H. Wanetick, F. P. Roschen, and J. M. Dunn, “Volvulus of the small bowel complicating pregnancy,” Journal of Reproductive Medicine for the Obstetrician and Gynecologist, vol. 14, no. 2, p. 82, 1973. [3] A. Andersson, L. Bergdahl, and W. Linden, “Volvulus of the cecum,” Annals of Surgery, vol. 181, no. 6, pp. 876–880, 1975. [4] W. B. Harer Jr. and W. B. Harer Sr., “Volvulus complicating pregnancy and puerperium; report of three cases and review of literature,” Obstetrics and Gynecology, vol. 12, no. 4, pp. 399– 406, 1958. [5] G. H. Ballantyne, M. D. Brandner, R. W. Beart Jr., and D. M. Ilstrup, “Volvulus of the colon. Incidence and mortality,” Annals of Surgery, vol. 202, no. 1, pp. 83–92, 1985. [6] A. Pal, E. Corbett, and N. Mahadevan, “Caecal volvulus sec- ondary to malrotation presenting after caesarean section,” Journal of Obstetrics and Gynaecology, vol. 25, no. 8, pp. 805– 806, 2005.