Intestinal obstruction in pregnancy—a rare presentation of uterine perforation

Abstract

Background Intestinal obstruction is an uncommon non-obstetric condition during pregnancy which may cause maternal and fetal mortality. Clinicians are confronted with challenges in diagnosis and treatment of intestinal obstruction due to the overlapping symptoms, concerns over radiological evaluation, and surgical risks. Case presentation We reported a 39-year old, gravida 7, para 2, woman who suffered from acute intestinal obstruction at 34 weeks of gestation. Ultrasonography and abdominal computed tomography were applied for intestinal obstruction diagnose. Conservative treatment was initially attempted. But following ultrasound found the absence of fluid in the amniotic sac and the patient showed no improvement in clinical symptoms. An emergency caesarean section was then performed. Intra-operative assessment showed dense adhesion between the left wall of uterus and omentum, descending colon, and sigmoid colon. After adhesion dialysis, uterine rupture with complete opening of the uterine wall at the site of left uterine cornua was found without active bleeding. The uterine rupture was then repaired. Conclusions Although uncommon during pregnancy, clinical suspicion of bowel obstruction is necessary especially in women with a history of abdominal surgery. Surgical intervention is indicated when conservative therapy fails and when there are signs of abnormal fetal conditions and worsened symptoms.

Cecal volvulus in pregnancy: A rare case report

“…It can be made using a plain abdominal X-ray (with 95 % sensitivity) or a CT scan, which is even more sensitive [ 1 ]. MRI is superior for bowel obstruction diagnosis due to its excellent soft tissue contrast, but its limited availability and time-consuming nature restrict its use [ 13 ]. Ultrasound's effectiveness in diagnosing bowel obstruction is limited.…”

Cecal Volvulus in Pregnancy, a Diagnostic Dilemma and Management: A Case Report and Literature Review

“…The limitations are mainly long scanning times, high cost, and availability. 18 In low-resource areas where a plain abdominal film is not available and there is a strong clinical suspicion for intestinal obstruction, early surgical exploration is also both diagnostic and therapeutic. Considering the setup of our hospital and the condition of the patient, the authors believe that it was an appropriate decision to send this patient to radiography and diagnose this rare but morbid condition early, with typical imaging findings suggestive of cecal volvulus.…”