Second Trimester Pregnancy and Adenomyosis Causing Sigmoid Colon Compressive Obstruction Complicating Sepsis: A Case Report and Literature Review

Abstract

Background: Gestational intestinal obstruction (GIO) is an uncommon but critical disease. Compared with other types of GIO, sigmoid colon compressive obstruction is even less likely to encounter in clinical practice. In this paper, we report the first case of sigmoid colon compressive obstruction complicating sepsis associated with pregnancy and adenomyosis. Case summary: A 28-year-old woman at 19+1 week of gestation presented to the emergency depart- ment with lower abdominal pain for 2 hours after meal. Ultrasound revealed intrauterine gestation, singleton alive, thick posterior uterine wall as well as adenomyosis suspected. Computed tomography (CT) revealed that the sigmoid colon was suspected to be compressed with intestine above the obstructive site in the state of dilation and gas loading. Con- servative treatment was initiated. However, at that night, the patient’s condition worsened and bedside ultrasound re- vealed singleton stillbirth. Laboratory examinations revealed sepsis. The patient was transferred to ICU and exploratory abdominal surgery was performed. Exploration confirmed that the sigmoid colon was adhered and compressed posterior to the uterus and proximal large intestines were dilated with multiple ruptures of seromuscular layer. Gastrointestinal decompression was performed with 20 cm of obstructive sigmoid colon removed. Two days Later, forceps curettage was performed. The patient recovered well after the surgery. Conclusions: We report the clinical presentations, diagnosis, etiology, treatment and prognosis of a pregnant patient with sigmoid colon compressive obstruction caused by the preg- nant uterus and adenomyosis. Timely diagnosis and treatment are of great significance to save maternal and fetal lives.