Authors
Zavrazhnov A.A.1, 2, 3, Soloviev I.A.1, 2, 3, Khanevich M.D.2, 3, Ogloblin A.L. 2, 3, Reutskij I.A.3, Andreenko A.A.1, 3, Luchinina D.V.3, Kiladze K.P.3
1 S.M. Kirov Military medical academy, St. Petersburg
2 St. Petersburg State Pediatric Medical University, St. Petersburg
3 Mariinsky Hospital, St. Petersburg
Abstract
Rationale: The incidence of intestinal obstruction in pregnancy is 1 in 17,000 births, representing a life-threatening condition for both mother and fetus, with fetal loss reported in 15% of cases, while maternal mortality rates reach approximately 2%. The pathology is rare, and does not fully reflect the course of diagnostic and therapeutic actions at the urgent surgical stage in a pregnant woman.
Objective: to demonstrate a rare clinical case of treatment of a pregnant woman at 25 weeks of gestation with acute adhesive small bowel obstruction.
Material and methods: patient K., 27 years old, 8 hours after the onset of the disease with suspected acute appendicitis and a 25-week pregnancy, complaining of constant nagging pain in the upper abdomen. Upon examination, a keloid scar from an upper-midline laparotomy (surgery on the diaphragm in infancy) was detected on the anterior abdominal wall. Laboratory tests — leukocytosis 14.1x109/L, neutrophyllosis 89%, other laboratory parameters without deviations from the norm. According to the results of ultrasound MRI of the abdomen, performed in dynamics, acute small intestinal obstruction was diagnosed. According to vital indications, laparotomy, adhestolysis, nasointestinal intubation, and drainage of the abdominal cavity were performed. Nodulation of the small intestine was diagnosed, without disruption of the blood supply to the intestinal wall. The operation was completed by layer-by-layer suturing of the anterior abdominal wall.
Results: the postoperative period was complicated by intestinal paresis and the threat of premature birth. The treatment allowed us to restore the peristalsis of the small and large intestines, prolong gestation and remove the threat of its interruption. The postoperative wound healed by primary intention. She was discharged on the 9th day after surgery. Gestation proceeded without complications; at the 38th week of pregnancy, a joint team of surgeons and obstetricians-gynecologists performed a Caesarean section, and a healthy boy was born, 3000 grams, 53 cm tall, with an Apgar score of 9 points.
Conclusion: the experience of treating a young pregnant woman showed that timely diagnosis and timely surgical care, calculated anesthesia allowed to preserve the life and health of the mother and fetus, prolong gestation until the physiological period of birth, thereby allowing the woman to give birth to a healthy child by Caesarean section at 38 months of age weeks.
Keywords: adhesive intestinal obstruction, adhesiolysis, surgical pathology in pregnant women.
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