Ileo-ileal knot causing small bowel obstruction and spontaneous fetal loss in a 25-week pregnancy: A case report

Small bowel obstruction (SBO) during pregnancy is a rare but potentially life-threatening condition, with high maternal and fetal morbidity. Among the rarest etiologies is ileo-ileal knotting, a rarely encountered surgical emergency with only seven reported cases in pregnancy, including one ileo-ileal knot, as per Shimizu et al. (2014). Its timely diagnosis is often hindered by overlapping obstetric and gastrointestinal symptoms.

We present the case of a 30-year-old woman at 25 weeks gestation who experienced severe abdominal pain, distension, and constipation for five days. Initially managed conservatively at a peripheral facility, she suffered a spontaneous fetal loss and was referred to a tertiary center. Exploratory laparotomy revealed an ileo-ileal knot with necrotic bowel, necessitating resection and primary anastomosis. Postoperative recovery was complicated by wound infection but resulted in full recovery with no long-term sequelae.

Ileo-ileal knotting results in rapid bowel ischemia and necrosis due to vascular compromise. Risk factors may include pregnancy-related bowel displacement and predisposing anatomical anomalies such as adhesions or Meckel's diverticulum. Diagnosis is often delayed due to atypical presentation and limited access to imaging in low-resource settings. Early surgical intervention remains the cornerstone of management, as delayed treatment significantly increases morbidity and mortality.

This case highlights the need for a high index of suspicion for rare causes of intestinal obstruction in pregnancy. Prompt surgical management can improve maternal and fetal outcomes. In low-resource settings, early clinical decision-making remains essential to preventing complications when advanced diagnostics are unavailable.