The clinical histories (including radiographs) of 4 patients who suffered from significant adynamic ileus or acute colonic pseudo-obstruction after cesarean section are presented. The main manifestations were vomiting, severe colicky pain, and abdominal distension. These can occur immediately after or within 2 days of the operation. Based on our experience, the risk factors for the development of adynamic ileus are significant peripartum hemorrhage leading to unstable hemodynamic status, severe constipation, use of meperidine for pain relief, and overt bowel manipulation. Mild enema and metoclopramide seem to be helpful in facilitating its resolution. Here, we examine how to differentiate mechanical bowel obstruction from adynamic ileus and look at how to prevent the occurrence of adynamic ileus while minimizing its severity and shortening its clinical course.
Pregnancies with a very large yolk sac are generally always associated with poor outcomes. Herein, we present a case in which a very large yolk sac (mean diameter, 8.1 mm) and a bicornuate uterus were shown on transvaginal sonography in the first trimester, but which resulted in a live birth. To our knowledge, this is the largest yolk sac among all cases accompanying live births which have been published in the literature. The unusual enlargement of the yolk sac may be secondary to the compensation effect for the poor blood supply in the medial wall of the bicornuate uterus for the conceptus. To predict the outcome of pregnancy, based on this case report, the quality of the yolk sac might be more important than its size.
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