Bowel obstruction in pregnancy caused by adhesions from previous abdominal surgery

Abstract

Introduction: During pregnancy, from second trimester the intra-abdominal viscera tend to get displaced from their normal position to accommodate the enlarging uterus. Normal anatomical and physiological change in pregnant woman makes a difficulty on differential diagnosis of acute abdominal pain if the causes are un-related to the pregnancy. Small bowel obstruction in pregnancy is rare and is most commonly caused by adhesions from previous abdominal surgery. Material and methods: In our case A 36-year-old female presented at 30 weeks gestation with 72-h of abdominal pain, nausea and vomiting without any appendectomy anamnesis. Laboratory investigations revealed a high normal white cell count WBC 16.1x109/ml, CRP -66.0mg/L. Hemoglobin, electrolytes, renal and liver function tests were normal. General surgeon suspected acute appendicitis. Ultrasounds showed dilatation of small bowels and slightly free fluids in between bowel loops with aviable foetus, and no inflamed appendix at RLQ of the abdomen cavity. Abdominal NECT showed dilatation of the small bowel loops which more than 4.0 cm sized diameter with air-fluid level, and collapsed large bowel loops, which started junction of the ileum with large intestine, surrounding by fat stranding and small air collections. Discussion: Our case is rare, and rare cause of bowel obstruction in pregnancy, and patient's symptoms resolved postoperatively and mother and baby discharged home on the tenth postoperative day. Our report purposed to develop the developing a strategy for timely diagnosis and management of pregnant women presenting with acute abdominal pain. Ultrasound is a first choice to exam the acute abdominal pain during pregnancy. However due to limitation of the this examination method, and MRI is an attractive alternative, and to CT, avoiding exposure to ionizing radiation5. Although, CT is generally more available than MRI, clinicians should be reluctant to use tests such as computed tomography because of radiation risk to the foetus.