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.

Keywords: Acute intestinal obstruction; Pregnancy; Uterine rupture.

Fig. 1

Axial (A) and coronal (B) views of computed tomography (CT) of the abdomen and pelvis. CT demonstrated gross distension of ascending colon and transverse colon

Fig. 2

Images of uterus and omentum taken during the emergency C-section. Dense adhesion was found between the left wall of uterus and omentum. After adhesion dialysis, signs of uterine rupture at the site of left uterine cornua was found without active bleeding

Fig. 3

Axial (A), sagittal (B), and coronal (C) views of CT of the uterus. CT showing discontinuity of the uterine muscle layer on the left cornua (white arrow) and adhesion between the ruptured site and omentum (red arrow)