Band adhesions in a virgin abdomen: A case report

Abstract

Introduction: Small bowel obstruction secondary to adhesions in a virgin abdomen is encountered very rarely. Its rarity may cause a delay in diagnosis that can lead to complications among which is sepsis and death. In contrast, On-time diagnosis constitutes one of many pillars of the best outcome for the patient.

Case presentation: We present a case of a 46-year-old female exhibiting symptoms of small bowel obstruction that persisted for five days. Her previous surgical history was negative. Upon testing, we found a neutrophilic leukocytosis and an abdominal x-ray revealed dilated bowel loops with multiple air-fluid levels and no air under the diaphragm with an increased pulse rate and respiratory rate. An emergency exploratory laparotomy definitively identified congenital band adhesions as the root cause of the obstruction.

Discussion: Abdominal x-ray is the starting investigation in rural health facilities of Low and Middle Income Countries (LMICs), but lacks the ability to detect complications such as strangulation and ischemia as can the multidetector Computed Tomography scan and the Magnetic Resonance Imaging. A non-resolving small bowel obstruction or the one associated with peritonitis or bowel ischemia should undergo a surgical intervention.

Conclusion: A negative surgical history should not annihilate the suspicion of band adhesions in small bowel obstruction. Early diagnostic imaging is helpful. When this is not possible, a laparotomy should be done if clinically indicated. The patient had an uneventful recovery.

Keywords: Band adhesions; Case report; Emergency laparotomy; Small bowel obstruction; Virgin abdomen.

Fig. 1

Anteroposterior erect abdominal x-ray.

Fig. 2

Intraoperative findings, Fig. 2A showing the overview of the findings, Fig. 2B, C, D showing respectively the three band adhesions causing the obstruction of the small bowel.