A multilevel obstruction of the digestive tract in a young female patient soon after delivery: a case report

Abstract

The article reports the case of a 31-year-old patient, in whom bowel ileus developed 2 days after natural delivery, and who in the second trimester underwent laparotomy due to mechanical obstruction involving the duodenum and small bowel and caused by swallowed foreign bodies. The course of pregnancy from the operation to delivery was uneventful. Preoperative diagnostics (barium meal) showed features of mechanical obstruction involving the duodenum and small bowel. The patient underwent surgery, and abdominal exploration revealed a largely distended duodenum filled by thick contents, dilated and involved in massive adhesions in the small bowel and a largely distended proximal colon. No site of critical stenosis of the bowel was found, and no other cause of disturbed intestinal passage was identified. Intraoperatively, no peristalsis was observed in the small bowel, although it was heard at abdominal auscultation before surgery. As adhesion release did not resolve the problem, a decision was made to discharge the small bowel and proximal colon by an incision of the caecum, followed by the formation of a cecostomy. Postoperative course was complicated by short episodes of upper digestive tract bleeding and diarrhoea, which disappeared soon after conservative therapy. The patient eventually recovered, and further gastroenterological investigations were inconclusive.