Acute intestinal obstruction in pregnancy after previous gastric bypass: A case report

Management of small bowel obstruction in the third trimester

Small bowel obstruction (SBO) in pregnancy is exceedingly rare. Management of SBO in the third trimester may pose particular challenges, as clinicians must determine whether or not the delivery of the fetus is indicated. In this report, we review the case of a patient in her mid-20's with no prior surgical history who presented with nausea and vomiting at 34 weeks of gestation and was ultimately diagnosed with an SBO. Following expectant management during the initial 4 days of inpatient admission, the patient subsequently underwent an exploratory laparotomy at 35 weeks without concurrent delivery. She was monitored for the remainder of her pregnancy with non-stress tests to evaluate fetal status and eventually underwent induction of labour at 39 weeks, resulting in a successful vaginal delivery. Herein, we review the challenges related to the diagnosis and management of SBO in pregnancy, as well as the maternal-fetal outcomes in the setting of SBO in the third trimester.

Midgut Volvulus in Disguise: Acute Abdomen in Early Pregnancy

Small bowel obstruction (SBO) in pregnancy is a challenging diagnosis. Case rarity, non-specific presentations, and the non-practicality of using X-ray/gamma-ray imaging modalities in pregnancy contribute to the increased difficulty in timely diagnosing midgut volvulus during pregnancy, thereby increasing maternal and fetal morbidity. We report a case of midgut volvulus in a 39-year-old lady, gravida 3, para 2, with two previous cesarean sections. Her only presenting complaint was abdominal pain for three days with no other associated symptoms. The case was successfully diagnosed using magnetic resonance imaging (MRI) and subsequently treated surgically by segmental resection with side-to-side ileocecal anastomosis, thereby saving the mother and fetus. Clinicians should have a low threshold of suspicion of the varied causes of SBO in pregnancy, particularly in patients with prior abdominopelvic surgeries. Imaging is central to preoperative diagnosis, and MRI has gained popularity with safety and accuracy comparable to computed tomography. Management aims at minimizing maternal and fetal morbidity and mortality.