630 Conservative Management for Recurrent Small Bowel Obstruction Related to Ileostomy in Pregnancy

Management of small bowel obstruction in pregnancy poses significant challenges, further complicated in rare cases where this is related to an ileostomy. Existing case reports describe both operative and conservative management strategies. This is the first case report to document conservative management of recurrent episodes. We report the case of a 27-year-old nulliparous patient, who presented at 24+0 weeks gestation with a short history of abdominal pain, bilious vomiting and reduced stoma output. She had a background of subtotal colectomy and ileostomy formation two years prior for refractory ulcerative colitis. MRI demonstrated small bowel obstruction with a transition point close to the ileostomy site. The obstruction was resolved through insertion of a per-stomal nasogastric tube, as in previous case reports, and she was discharged. At 27+0 weeks she was readmitted with recurrent symptoms, to relieve the obstruction a Foley catheter was placed into the ileostomy to traverse the transition point and positioning confirmed on MRI, allowing discharge. At 34+5 weeks she was readmitted and managed similarly, however it became apparent the gravid uterus was contributing to obstruction and early delivery was the best option. She received dexamethasone and underwent an uncomplicated caesarean section at 35+2 weeks with the stoma functioning normally post-delivery. She was successfully discharged with her baby. In conclusion, novel use of a Foley catheter permitted oral nutrition and time for steroid administration to aid foetal lung maturation. Joint care with obstetrics was vital to determine optimal timing for delivery, balancing risk to the mother and pre-term delivery.