AB165. SOH22ABS180. A rare case of small bowel obstruction and volvulus in a post-partum patient

Background: We present the case of a 33-year-old female, who underwent emergency small bowel resection with end ileostomy formation day 1 post spontaneous vaginal delivery, secondary to acute large bowel obstruction with coexistence volvulus.

Methods: Eight hours post spontaneous vaginal delivery (SVD) our patient became acutely unwell, with chest pain, hypotension, tachycardia and a reduced Glasgow Coma Scale (GCS). Extensive investigations with multiple disciplinary meeting (MDT) input of obstetrics, anaesthetics and ICU alongside multiple imaging modalities where a computerized tomography abdomen pelvis (CTAP) demonstrated multiple uterine fibroids, the largest of which measured 15 cm, causing compression of the distal descending/proximal sigmoid colon with associated high grade large bowel obstruction.

Results: She underwent a laparotomy which revealed approximately 6 fibroids, the largest of which was pedunculated and had incarcerated and volvulated the bowel causing it to become ischemic which subsequently resulted in resection and an ileostomy 150 cm from the duojejunal flexure. There was 7 cm of the terminal ileum proximal to the ileocecal valve retained. She subsequently made a good recovery.

Conclusions: She had one previous presentation of small bowel obstruction (SBO) in 2016 outside of pregnancy which was treated conservatively. Our patient was keen to preserve her fertility and underwent successful reversal of her end ileostomy and multiple myomectomy on the same day, 20 months after her initial maternal collapse. She has made a good post operative recovery. A review of the literature indicates that SBO post SVD secondary to fibroids is incredibly rare and, where reported, followed a caesarean section or occurred intrapartum.

Keywords: End ileostomy; fibroids; post-partum; small bowel obstruction (SBO); volvulus