Postpartum acute abdomen and its diagnostic challenges

Abstract

This is the case of a 25-year-old primigravida with gradual onset abdominal pain and vomiting, 1 day postvaginal delivery. After three hospital admissions over the following 3 weeks, a diagnosis of small bowel obstruction secondary to adhesions was made; the patient had undergone a previous appendicectomy. The patient was taken to theatre for laparotomy and adhesiolysis, where the bowel was found to be viable but with two small serosal tears. Postoperative recovery was uncomplicated. This case highlights the importance of assessing abdominal pain in the puerperium in a similar manner to that done in a non-pregnant state, to avoid delay in diagnosis.

Small Bowel Obstruction in Postpartum Vaginal Delivery due to Prior Abdominal Adhesions Case Report

“…The best modern imaging diagnostic technique in the postpartum period in the context of a challenging diagnosis is CT of the abdomen and pelvis. Relying other imaging may delay care, such as in another case report of a postpartum small bowel obstruction diagnosed 17 days postpartum following insidious onset from postpartum day 1 [ 18 ]. In that case, the diagnostic imaging initially used was ultrasound, which showed free fluid, but the diagnosis of obstruction was revealed subsequently with CT abdomen and pelvis.…”

Spontaneous intraperitoneal rupture of a postpartum rectus sheath haematoma

“…This poses a bigger diagnostic challenge in patients presenting in the postpartum period due to the additional consideration given for intrauterine postpartum complications in the differential diagnosis 5. Patients may also present with an abdominal mass, mild fever and leukocytosis 6.…”