1616 Unusual Baby Bump: Hidden Pregnancy in the Setting of Chronic Opioid-Induced Pseudo-Obstruction

Abstract

INTRODUCTION: Opioid addiction and abuse have become a serious public health problem in the United States. The most common gastrointestinal adverse effect is dysmotility and decreased peristalsis, manifesting as constipation. We present an extreme case of a young woman with chronic constipation in the setting of opioid abuse. Imaging obtained during her diagnostic workup revealed unexpected findings and further highlight the consequences of the opioid crisis in the United States. CASE DESCRIPTION/METHODS: A 26-year-old woman with known opioid-induced chronic constipation (OIC) presents to an outside emergency department with abdominal pain, distention, and leakage of yellow-brown fluid from the anus and vagina. She had been admitted multiple times over the course of the past year for management of chronic pseudo-obstruction. Outside abdominal computed tomography (CT) revealed a diffusely dilated colon with large amounts of stool. Incidentally, an advanced intrauterine pregnancy was identified on imaging. The patient was unaware of the pregnancy. Ultrasound exam was consistent with a gestational age of 32 weeks and 6 days complicated by oligohydramnios and cord prolapse. The patient underwent emergent cesarean delivery without immediate complications. Flexible sigmoidoscopy was performed following delivery. Extensive amounts of solid stool were removed with digital disimpaction and copious lavage. During hospitalization, the patient was counseled regarding opioid abuse, management of chronic constipation, and scheduled for outpatient follow-up. DISCUSSION: The opioid epidemic in the United States has reached epic proportions, with drastic consequences on public health. OIC is the most frequent and prevalent adverse effect among opioid users. While conventional and new laxatives have been shown to be effective for OIC, focus should be shifted towards awareness and prevention of opioid abuse. Another important note to be made is the importance of history taking on a patient with multiple hospitalizations with similar presentations. While she did have an extraordinary stool burden that did require manual disimpaction, the patient was also found to be in her third trimester of pregnancy on CT imaging. Fortunately, no harm occurred to the patient or child, however obtaining the proper history and diagnostic work-up could have helped limit any potential injury that might have resulted.