Impingement by a polymyomatous uterus: a rare cause of large bowel obstruction

Abstract

A primiparous female developed acute large bowel obstruction Day 1 post lower segment Caesarean section. Initially presumed to be post-operative ileus, increasing abdominal pain and distension over the next 24 h prompted a surgical consult. Computed tomography imaging demonstrated an abrupt transition point of the large bowel behind a polymyomatous uterus. Although this case resolved with vigorous patient mobilization, literature review reveals previous cases resolving only after intraoperative mobilization of the uterus. It is distinct from ileus as bowel sounds are present, onset is abrupt, progression is rapid and mobilization of the uterus causes immediate resolution. This condition is likely to be more common than the literature would suggest, its scarcity partially due to the reluctance to image young females especially during pregnancy.

Cervical myoma causing colonic obstruction in the first trimester of pregnancy – a case report

“…The management of extremely rare clinical situations is always challenging because of the limited evidence. Obstruction in the second to third trimester of pregnancy or caused by expansive pathology of the uterus or cervix has been described previously [ 4 , 6 ]. However, when reviewing the literature, no other publications of large bowel obstruction in the first trimester secondary to cervical myomatosis as presented in this report could be found.…”