The Post Partum Uterus –A Rare Cause of Mechanical Large Bowel Obstruction

Case Presentation

Austin J Surg. 2018; 5(1): 1122.

The Post Partum Uterus –A Rare Cause of Mechanical Large Bowel Obstruction

Li R¹*, Dooreemeah D² and Cichowitz A³

¹Department of Specialist General Surgery, The Royal Melbourne Hospital, Parkville, Australia

²Department of Surgery, St Vincent’s Hospital, Fitzroy, Australia

³Department of Surgery, Northeast Health, Wangaratta, Australia

*Corresponding author: Li R, Department of Specialist General Surgery, Royal Melbourne Hospital, Australia

Received: December 04, 2017; Accepted: January 15, 2018; Published: February 08, 2018


Large bowel obstruction in the immediate post-partum period is rare. Reported mechanical causes include compression by extrinsic masses such as uterine growths or foreign bodies, which usually require operative intervention. We report a case of a 43-year-old woman with mechanical large bowel obstruction secondary to a post-partum uterus. This was diagnosed clinically, confirmed on computed tomography scan and successfully managed conservatively. This is the reported first case of large bowel obstruction caused by a post-partum uterus in the literature and demonstrates that this unusual presentation may be managed conservatively in the clinically well patient.

Keywords: Uterus; Large bowel obstruction; X-ray

Case Presentation

We present a case of a 43 year old woman, who was referred to the general surgery team two days post emergency Caesarean section. She had an uncomplicated lower uterine segment Caesarean section for failure to progress post induction of labour. She gave birth to a healthy, full term neonate.

The patient described 24 hours of worsening central colicky abdominal pain, distension, nausea and vomiting. She had not opened her bowels since the surgery, but was still passing small amounts of flatus, albeit infrequently. The obstetrics team initially treated her for presumed post-operative ileus and had given her oral and per rectal aperients. Prior to this Caesarean section, she had had four vaginal deliveries but no previous surgeries. There is no other significant past medical history and she did not take any regular medications.

On initial examination, she looked well but in discomfort. Her blood pressure was 130/80, heart rate 90, SaO2 99% on room air, respiratory rate 16, temperature 37.3, GCS 15. Her abdomen was grossly distended with mild generalised tenderness but no peritonism. Bowel sounds were completely absent and her caesarean wound was unremarkable. Erect and supine abdominal X-rays demonstrated moderately distended loops of large and small bowel with multiple air fluid levels and no gas in the rectum. Due to concern about a large bowel obstruction, a CT abdomen with intravenous and nasogastric contrast was performed. This scan revealed a partial mechanical large bowel obstruction with the transition point at the sigmoid colon. The obstruction appeared to be due to extrinsic compression from the adjacent enlarged, post partum uterus (Figure 1).

Citation: Li R, Dooreemeah D and Cichowitz A. The Post Partum Uterus –A Rare Cause of Mechanical Large Bowel Obstruction. Austin J Surg. 2018; 5(1): 1122.