The Role of Increasing Serum C-reactive Protein Level in Diagnosis of Post-surgery Small Bowel Pseudo-obstruction: A Case Report

Abstract

Introduction: Acute colonic pseudo-obstruction (APCO), which is identified as colon dilatation without any mechanical obstruction, is a rare post-surgery complication. Case Presentation: Herein, we report a 40-year-old woman who underwent total laparoscopic hysterectomy with no complications during the surgery. On post-op visits, she complained of vague abdominal pain, especially in the upper quadrants, with a mild abdominal distention on her physical examination. Despite normal abdominal imaging, C-reactive protein (CRP) level was rising. Although oral intake was discontinued, the abdominal distention progressed gradually, and CRP levels rose continuously. On the fifth post-surgery day, the patient was suffering from bilious vomiting. Additionally, the abdominal distention was accompanied by tenderness. Emergency laparotomy was scheduled for clinically suspected bowel problems that were resistant to conservative management. During emergency laparotomy, the small bowel was distended. Since 20 cm of ileum was ischemic due to bowel congestion, segmental resection and anastomosis were performed. Conclusions: The CRP value can help to predict latent complications. It is also necessary to observe these patients closely to detect and manage probable post-operation complications.