MISSED ON ULTRASOUND, CAUGHT ON MRI: A CASE OF CLOSED-LOOP SMALL BOWEL OBSTRUCTION IN PREGNANCY
Main Article Content
Abstract
Small bowel obstruction (SBO) in pregnancy presents a diagnostic challenge due to overlapping symptoms between obstetric and gastrointestinal conditions. We report a case of a 27-year-old woman at 26 weeks and 6 days of gestation with a late-stage closed-loop obstruction that was initially misdiagnosed on ultrasound.
This is a patient with a history of open appendectomy and open ovarian cystectomy, who presented with persistent right-sided abdominal pain, vomiting, and absence of bowel movements. Initial imaging at a referring hospital suggested enteritis and raised concerns for threatened preterm labor. Upon transfer to our facility, our ultrasound revealed dilated small bowel loops with minimal peristalsis and echogenic free fluid in the right iliac fossa, suggesting possible ischemia SBO, but findings were inconclusive. MRI was performed and showed clustered dilated loops, transition point, mesenteric edema, free ascites, and the small bowel feces sign - findings consistent with closed-loop obstruction.
The patient underwent emergency laparotomy, which confirmed twisted, necrotic ileal loops. Resection and ileocecal anastomosis were performed. Both maternal and fetal conditions remained stable postoperatively.
The patient underwent emergency laparotomy, which confirmed twisted, necrotic ileal loops. Resection and ileocecal anastomosis were performed. Both maternal and fetal conditions remained stable postoperatively.
This case highlights the importance of accurate evaluation, timely diagnosis and intervention in SBO during pregnancy. MRI should be considered early when ultrasound results are inconclusive, as it can provide critical information without exposing the patient to radiation. Delayed diagnosis may result in severe complications, including bowel necrosis and adverse pregnancy outcomes.
Keywords
MRI in pregnancy, emergency abdominal imaging, closed-loop small bowel obstruction
Article Details
References
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