Small bowel obstruction in pregnancy is a complex surgical problem with a high risk of fetal loss

Abstract

INTRODUCTION Small bowel obstruction (SBO) in pregnancy is rare and is most commonly caused by adhesions from previous abdominal surgery. Previous literature reviews have emphasised the need for prompt laparotomy in all cases of SBO because of the significant risks of fetal loss and maternal mortality. We undertook a review of the contemporary literature to determine the optimum management strategy for SBO in pregnancy. METHODS The MEDLINE ® and PubMed databases were searched for cases of SBO in pregnancy between 1992 and 2014. Two cases from our own institution were also reviewed. RESULTS Forty-six cases of SBO in pregnancy were identified, with adhesions being the most common aetiology (50%). The overall risk of fetal loss was 17% and the maternal mortality rate was 2%. In cases of adhesional SBO, 91% of cases were managed surgically, with 14% fetal loss. Two cases (9%) were managed conservatively with no complications. Magnetic resonance imaging (MRI) was used to diagnose SBO in 11% of cases. CONCLUSIONS Based on our experience and the contemporary literature, we recommend that urgent MRI of the abdomen should be undertaken to diagnose the aetiology of SBO in pregnancy. In cases of adhesional SBO, conservative treatment may be safely commenced, with a low threshold for laparotomy. In other causes, such as volvulus or internal hernia, laparotomy remains the treatment of choice.

Role of Multidetector Computed Tomography with Multiplanar and Curved Multiplanar Reformations in the Detection of Cause of Intestinal Obstruction: A Tertiary Care Experience

“…No case of intra-abdominal pregnancy causing a bowel obstruction has been reported so far. This was a rare case of small bowel obstruction [13].…”

Internal Herniation in Pregnancy After Gastric Bypass

“…An early surgical approach is also endorsed by others. 36 We should warn that two factors may have led us to overestimate the severity of the disease. First, our hospital serves as a referral center, and it could well be that only the more complicated cases were referred to us.…”

Extensive small bowel gangrene at mid-term pregnancy with fruitful outcome

“…2 Adhesions due to previous surgery were reported to be most common causes of mechanical intestinal obstruction complicating pregnancy. [3][4][5] In our, patient no history of previous surgery was reported, possibly a congenital band was the reason for the mechanical intestinal obstruction in her case thus the virgin abdomen does not preclude the presence of an intestinal obstruction with pregnancy. 6 The virgin abdomen adds to the ambiguity of the problem.…”