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Duodenal Obstruction during Pregnancy.

Mansooreh Haghiri1, Sedigheh Borna1, Kamran Hessami2,3

  • 1Maternal, Fetal and Neonatal Research Center, Vali-e-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran.

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Summary
This summary is machine-generated.

Intractable vomiting in pregnancy can signal surgical emergencies, not just obstetric causes. Early diagnosis of duodenal obstruction, like Ladd's band, is crucial for maternal and infant well-being.

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Area of Science:

  • Gastroenterology
  • Obstetrics
  • Surgical Emergencies

Background:

  • Pregnancy commonly presents with nausea and vomiting, often attributed to obstetric causes.
  • Elevated liver function tests (LFTs) during pregnancy typically prompt investigation into obstetric etiologies.
  • Acute surgical conditions must be considered in pregnant patients with persistent vomiting and abnormal LFTs.

Observation:

  • A 26-year-old pregnant woman at 18 weeks gestation experienced intractable vomiting, weight loss, and elevated LFTs without abdominal pain.
  • Abdominopelvic ultrasound was unremarkable, but magnetic resonance imaging revealed duodenal dilation and collapse.
  • Exploratory laparotomy identified duodenal obstruction due to Ladd's band.

Findings:

  • Surgical correction of duodenal obstruction (Ladd's operation) resolved the patient's vomiting and normalized LFTs.
  • The patient resumed oral intake, gained significant weight, and delivered a healthy infant at 36 weeks gestation.
  • This case highlights the importance of considering non-obstetric surgical causes for severe gastrointestinal symptoms in pregnancy.

Implications:

  • Clinicians should maintain a high index of suspicion for surgical emergencies, including small bowel obstruction, in pregnant patients with unexplained vomiting and abnormal LFTs.
  • Timely diagnosis and surgical intervention are vital for favorable maternal and fetal outcomes in such cases.
  • Integrating advanced imaging and surgical consultation can improve diagnostic accuracy and management of rare pregnancy-related surgical complications.