179 Postpartum Uterus Causing Mechanical Bowel Obstruction

Background

Intestinal obstruction is a common surgical emergency. Common causes of mechanical large bowel obstruction include malignancy, sigmoid volvulus, and diverticular disease. Due to the risk of bowel ischaemia and perforation, large bowel obstruction requires urgent recognition and treatment to prevent morbidity and mortality.

Case Presentation

35-year-old female developed nausea, vomiting and abdominal pain two days post emergency cesarian section at 39+5 weeks gestation. An abdominal X-Ray showed distended loops of large bowel and mechanical large bowel obstruction with a sigmoid transition point was diagnosed on CT. She was referred to the surgical team for further management and a flexible sigmoidoscopy under general anaesthetic was performed for decompression.

Results

The patient was reviewed the following day. She was asymptomatic and had opened her bowels. She was discharged from surgical follow-up at this stage following successful treatment and was able to return home with a healthy baby.

Conclusions

Mechanical compression from a postpartum uterus is a rare cause of mechanical large bowel obstruction, with just one previous case documented in the literature. Acute colonic pseudo-obstruction (Ogilvie syndrome) is a recognised postpartum complication, more common after cesarian section and an important differential with similar treatment options.

The recommend diagnostic imagining includes abdominal x-ray and/or CT scan with early surgical referral for consideration of interventional or surgical management in patients presenting with symptoms of bowel obstruction in the postpartum period. Conservative management should include lateral decubitus position.