Abstract
BackgroundAcute intestinal obstruction during pregnancy is a rare digestive surgical emergency with significant maternal and fetal mortality. Diagnosis is difficult, often delaying the management. Here, we report an exceptional association of mechanical acute intestinal obstruction due to compression by previa uterine leiomyoma, and a ruptured ectopic pregnancy.Case presentationThis is the case report of a 43-year-old primiparous black woman from a rural area, who was admitted to the surgical emergency department for acute intestinal obstruction.At examination on admittance, our patient had a bad general condition with clinical anemia. She had an occlusive syndrome that had been evolving for 3 days. A physical examination of her abdomen showed a widespread distension with an irregular and polylobed solid mass occupying the whole of the lower-umbilical and hypogastric area. A rectal examination found an empty rectum, and the mass was perceptible in Douglas’s pouch. At the vaginal examination, we found the same mass and a finger holster was clean. The diagnosis of intestinal occlusion by a tumor was retained. The laparotomy revealed a distended intestine, a ruptured right tubal ectopic pregnancy and a polymyomatous uterus. The most massive previa leiomyoma was adhering and compressing the rectal and sigmoidal hinge. A total hysterectomy was performed and histopathological examination of specimens confirmed myoma and ectopic pregnancy. The surgical follow-up was uneventful, and our patient was discharged on postoperative day 12.ConclusionsThe etiological diagnosis of acute intestinal obstruction during pregnancy is not easy, especially in the context of a low-income country where the means of biological and radiological diagnosis are lacking. A laparotomy is required before diagnosis of acute surgical abdomen and its management will depend on the intraoperative findings and the condition of the patient.
Highlights
Acute intestinal obstruction during pregnancy is a rare digestive surgical emergency with significant maternal and fetal mortality
A laparotomy is required before diagnosis of acute surgical abdomen and its management will depend on the intraoperative findings and the condition of the patient
We report our experience on the management of a patient with ectopic pregnancy and a compressive polymyomatous uterus, discovered during a laparotomy for acute intestinal occlusion
Summary
The etiologic diagnosis of AIO during pregnancy is difficult. In the Nigerien context, characterized by the unavailability of modern imaging equipment, hesitation has no place in the face of an obvious diagnosis of an acute surgical abdomen of the woman. Laparotomy is necessary, and the surgical procedure must take into account the peroperative findings, the age, the antecedents, and the patient’s desire of pregnancy
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