Adhesive small bowel obstruction in pregnancy and the use of oral contrast media: a case report

Abstract

Bowel obstruction in pregnancy is a high risk situation for both the mother and baby. We present a case of a 30-week-pregnant woman who presented with abdominal pain and vomiting and was diagnosed with adhesive small bowel obstruction (SBO). Oral contrast media was successfully used as a treatment. The patient was discharged home and 10 weeks later delivered a healthy baby girl. We were unable to find any cases in the literature describing oral contrast media to treat adhesive SBO in pregnancy. From our experience and research, we consider oral contrast media as a method of treating adhesive SBO in pregnancy under the proviso that there are no signs that indicate urgent surgical intervention.

Successful Vaginal Delivery during Acute Small Bowel Obstruction: A Case Report and Review of the Literature

“…In our review, there was a total of 54 cases of small bowel obstruction during pregnancy from a total of 32 sources during the included timeframe (Tables 1 and 2 ). Eight of these sources, corresponding to 28 cases, did not discuss the mode of delivery [ 2 , 11 , 17 , 21 , 25 , 30 , 32 , 41 ]. Of the total 26 cases of small bowel obstruction from 24 sources during pregnancy with a specified mode of delivery, 65.4% (17/26) were ultimately delivered via cesarean delivery.…”

“…Delayed diagnosis can result in bowel strangulation and can be detrimental to both the mother and fetus [ 5 , 13 , 40 ]. Studies suggest that maternal mortality and fetal loss in cases of bowel obstruction during pregnancy range from 2-4% to 13-17%, respectively [ 1 , 41 , 43 , 44 ].…”

Management of small bowel obstruction in the third trimester

“…We generated a total of 53 unique detailed cases of SBO in the third trimester of pregnancy excluding our case (figure 1). Factors from the literature review cases6–58 included maternal age, gestational age at the time of presentation, presenting symptoms, imaging modalities used, inpatient management approach, surgical route if applicable, intraoperative fetal heart rate monitoring if applicable, delivery timing, route of delivery, maternal outcomes, fetal outcomes and length of hospitalisation as outlined in the (online supplemental table 1). The data were extracted to a custom-made inclusive table outlining all the variables highlighted in table 1.…”

Midgut Volvulus in Disguise: Acute Abdomen in Early Pregnancy

“…Adhesions from prior abdominal surgeries are the most common etiology for mechanical SBO, accounting for 60-70% of cases. The remaining cases are due to volvulus (25%) and intussusception (5%) [ 1 , 2 , 4 ]. The incidences during the first, second, and third trimesters and puerperium are reported as 6%, 28%, 45%, and 21%, respectively [ 1 , 2 ].…”

“…Small bowel obstruction (SBO) in pregnancy is a rare challenging diagnosis, with a reported incidence of 1 in 17,000 deliveries [ 3 ]. Case rarity, non-specific presentations, and the contraindication of X-ray/gamma-ray imaging modalities in pregnancy contribute to the increased difficulty in timely diagnosing SBO during pregnancy, thereby significantly increasing maternal (2% to 4%) and fetal (13 to 17%) mortality [ 3 , 4 ]. Here, we report the successful detection and management of a case of small bowel volvulus in a pregnant lady with prior pelvic surgery utilizing magnetic resonance imaging (MRI).…”