Conservative Versus Operative Management of Small Bowel Obstruction in Pregnancy: An Updated Review of the Current Literature

BACKGROUND: Small bowel obstruction (SBO) in pregnancy is rare but associated with high maternal and foetal morbidity. The incidence of this is rising with increasing rates of stoma formation in women of reproductive age. METHODS: A stratified systematic search of MEDLINE, EMBASE and PubMed was conducted for cases published between 01/01/2015 and 31/12/2023. Cases were evaluated following PRISMA guidelines. Management strategies (operative, successful conservative, failed conservative) and outcomes including mortality and preterm delivery were analysed. A case of novel stomal decompression is presented. RESULTS: This study reports a case of successful conservative management in late pregnancy SBO alongside an updated review of the literature. A 27-year-old woman with recurrent SBO was successfully managed conservatively with stomal Foley catheter decompression, avoiding surgery. Our systematic review identified 44 cases: 32/44 (72.7%) managed operatively and 12/44 (27.3%) had an initial trial of conservative management, 8/44 (18.2%) successful and 4/44 (9.1%) failed. Adhesions were the primary aetiology (19/44, 43.2%). Preterm delivery was 0/8 (0%) in the successful conservative group compared to 17/32 (53.1%) in the operative group and 3/4 (75.0%) in the failed conservative group. Overall maternal mortality was 3/44 (6.8%) and foetal mortality 5/44 (11.4%). MRI utilisation increased to 17/44 (38.6%) cases. CONCLUSION: A trial of conservative management appeared feasible in carefully selected, stable patients and was associated with fewer preterm deliveries. Early MRI, multidisciplinary care and minimally invasive decompression techniques may help optimise outcomes.