Large Bowel Obstruction Caused by Adhesions without Previous Abdominal Surgery: Two Case Reports

Abstract

Background: Large bowel obstruction is rarely caused by adhesions. To our knowledge, the few cases reported in literature are secondary to previous abdomino-pelvic surgery, and are in female patients. Case Reports: We report two cases of large bowel obstruction due to adhesions in males with no previous abdominal surgery. The first case was a 73 years old male previously well, who presented with a one week history of abdominal colicky pain with nausea. Initially this patient was thought to have symptomatic gallstones as a result of an ultrasound scan report. Consequently, a decision to take the patient for laparoscopic cholecystectomy was reached. Due to difficulties in achieving penumoperitoneum, a laparotomy was done; the patient was found to have a fibrous band across transverse colon causing obstruction. The second case was a 61 years old male, known diabetic and hypertensive, who presented with epigastric pain, nausea, vomiting and constipation. Abdominal X-rays demonstrated large bowel obstruction. At laparotomy, this patient was found to have adhesions causing sigmoid colon obstruction. Conclusion: In this paper, we demonstrate the rarity of large bowel obstruction secondary to adhesions especially in a virgin abdomen, emphasize the importance of good radiological expertise, and highlight the need to consider adhesions as a very rare but possible cause of large bowel obstruction.