DOI: 10.12688/f1000research.180014.1 ISSN: 2046-1402

Case Report: Intestinal Obstruction in Pregnancy Due to a Degenerating Uterine Leiomyoma

Oumayma Mejri, mehdi binous, zeineb ben dhiaf, Hamza Ben Abdallah, Fahd Khefacha, mohamed raouf ben othman, Maroua Yengui, chiraz elfekih
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Background Uterine fibroids are the most common benign tumors in women, affecting up to 40–60% of women. Although frequently encountered during pregnancy, complications such as degeneration are uncommon. Conversely, small bowel obstruction (SBO) in pregnancy is a rare but potentially life-threatening condition, with an estimated incidence of 1 in 1,500 pregnancies. An association between SBO and uterine fibroids is exceptionally rare, with few cases reported in the literature. We present a unique case of SBO in pregnancy caused by a large degenerated fibroid, emphasizing the diagnostic and surgical challenges of this rare association. Case presentation A 31-year-old primigravida at 28 weeks of gestation presented with acute-onset pelvic pain and persistent vomiting. She was hemodynamically stable, afebrile, and had localized tenderness in the right iliac fossa without peritoneal signs. Fetal movements were active. Laboratory tests showed markedly elevated CRP. Abdominal ultrasound revealed jejunal distension, a large subserosal uterine fibroid with features of necrobiosis, moderate free intraperitoneal fluid, right-sided pyelocaliceal dilatation, and a gallbladder calculus. Initial management included nasogastric decompression and intravenous fluids. Due to persistent symptoms, an abdominopelvic CT scan showed small bowel dilatation with a transitional zone and a whirl sign around a twisted vascular pedicle adjacent to the fibroid, consistent with mechanical small bowel obstruction. Emergency laparotomy revealed a large subserosal fibroid with a small bowel loop adherent via an adhesive band forming a partial volvulus. No bowel ischemia was present. Adhesiolysis and division of the fibrous band relieved the obstruction without bowel resection. Postoperative recovery was uneventful, with reassuring fetal monitoring. At 35 weeks, she had spontaneous preterm labor and delivered a healthy male infant. Both mother and newborn remained well. Conclusion This case highlights the importance of timely diagnosis and intervention in mechanical bowel obstruction during pregnancy, ensuring favorable maternal and fetal outcomes despite preterm delivery.

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