409. Small bowel obstruction secondary to congenital peritoneal band in pregnancy: A case study

Abstract

Small bowel obstruction in pregnancy continues to be a rare and dangerous presentation, with the potential for fatal outcomes to both mother and foetus. As of yet, there is no consensus of management for this condition. We describe the case of a 40 year old IVF twin DCDA primigravida pregnancy, who presented at 20 weeks with abdominal pain and vomiting. Past surgical history included myomectomy. She was found to have small bowel obstruction and necrosis secondary to a congenital peritoneal band. A review of existing literature was conducted using several databases to compare previous management of similar conditions. The patient presented with epigastric pain, nausea and vomiting. On examination she was haemodynamically stable and both foetal heartbeats were heard. Initial management was medical, with intravenous fluids, anti-emetics and analgesia. Both pain and nausea worsened over 3 days. Abdominal ultrasound found prominent static bowel consistent with obstruction and the patient was referred urgently to the general surgeons. Further MRI confirmed the diagnosis. She underwent an emergency laparotomy, resection of small bowel (30 cm) and primary anastomosis. Recovery was complicated by post-operative ileus managed conservatively. She was discharged to complete a course of dalteparin during pregnancy and 6 weeks post-partum. The pregnancy continued to full term, delivering via elective C-section without issue at 37 weeks. Abdominal pain within pregnancy can offer a wide breadth of differentials and obstruction can be difficult to recognise. A low threshold for alternative diagnoses must therefore be kept for these examples. Equally, urgent imaging is key. Although contemporary management favours magnetic resonance (MR) imaging in order to minimise the effects of radiation on the foetus, organisation of this should not delay diagnosis and treatment. Ultrasound can be a useful alternative. Close partnership between surgical teams is also paramount.