Fatal small bowel perforation complicating intestinal obstruction in pregnancy: A case report

BACKGROUND Intestinal obstruction (IO) in pregnancy, though rare (1:1500-1:66000), carries high maternal (6%-10%) and fetal mortality (26%). Adhesions from prior surgery are the leading cause. Diagnosis is often delayed due to symptom overlap with normal pregnancy, increasing risks of perforation and sepsis. CASE SUMMARY A 25-year-old gravida 2 para 1 woman at 28 weeks of gestation presented with 1-week constipation, feculent vomiting, and abdominal distension. She had a history of exploratory laparotomy in 2015 for blunt abdominal trauma. The diagnosis of IO in pregnancy was confirmed via abdominopelvic ultrasound and clinical findings. Interventions included conservative measures (nasogastric tube decompression, enemas) followed by emergency laparotomy with bowel resection/anastomosis. Despite surgical management, the patient succumbed to septic shock. CONCLUSION High clinical suspicion, expedited cross-sectional imaging (computed tomography/Magnetic resonance imaging), and emergent surgery are critical to reduce mortality.