Massive small bowel resection during pregnancy causing short bowel syndrome

Area of Science:

• Gastroenterology
• Obstetrics & Gynecology
• Surgical Oncology

Background:

• Massive small bowel infarction during pregnancy presents diagnostic challenges due to masked symptoms.
• This condition can lead to devastating complications for both mother and fetus.

Purpose of the Study:

• To assess the risk factors and outcomes associated with massive small bowel resection during pregnancy.
• To improve the diagnosis and management of this rare but severe complication.

Main Methods:

• A retrospective review of nine patients who developed short bowel syndrome (SBS) secondary to massive bowel resection during pregnancy.
• Analysis of patient histories, surgical causes, and post-operative outcomes, including nutritional support and complications.

Main Results:

• Midgut volvulus was the most common cause (7/9 patients), often associated with malrotation or previous abdominal surgeries.
• Vascular insufficiency was noted in two patients.
• Three fetal deaths occurred, and all surviving patients required parenteral nutrition (PN) due to resulting short bowel length (<60 cm).
• Seven patients experienced significant complications related to SBS and PN; four ultimately required transplantation.

Conclusions:

• Massive small bowel resection in pregnancy is a rare, severe complication requiring high clinical suspicion for diagnosis.
• Identified risk factors include prior surgery, congenital malrotation, and hypercoagulable states.
• Long-term PN or transplantation is typically necessary for surviving patients, highlighting the critical nature of this condition.