Adhesional Small Bowel Obstruction at Term: Unmasking a Rare Surgical Emergency in Late Pregnancy

Small bowel obstruction (SBO) in pregnancy is an uncommon but potentially life-threatening condition, most commonly caused by adhesions. Its presentation often overlaps with benign gastrointestinal symptoms of pregnancy, making diagnosis challenging and potentially delaying intervention. We report a 38-week primigravida who presented with upper abdominal pain, vomiting, and reduced foetal movements. She was haemodynamically stable with normal laboratory investigations, and MRI demonstrated features of distal small bowel obstruction without a clear transition point. Given the gestational age and persistent symptoms, a caesarean section was performed. Intraoperatively, a fibrous band adhesion across the terminal ileum, causing distal obstruction, was identified, clipped, and divided through the caesarean incision. Both mother and neonate recovered well, and postoperative recovery was uneventful. This case highlights the diagnostic difficulty of SBO in pregnancy and supports the role of MRI as a safe and effective imaging modality. It also demonstrates the value of multidisciplinary coordination between obstetricians, surgeons, and anaesthetists in optimising outcomes. In selected term patients, addressing obstructing adhesions at the time of caesarean delivery may avoid a separate laparotomy, thereby reducing operative morbidity and facilitating faster recovery.