Idrees Salman, Bellomo Alessandro, Luvhengo Thifhelimbilu
University of the Witwatersrand, South Africa.
Charlotte Maxeke Johannesburg Academic Hospital, South Africa.
Int J Surg Case Rep. 2023 Oct;111:108806. doi: 10.1016/j.ijscr.2023.108806. Epub 2023 Sep 9.
Adhesions and external hernias are the two most common causes of small bowel obstruction. Perforation of organs within the abdomen or pelvis following manual vacuum aspiration is known to lead to an acute presentation.
We report a case of a 33-year-old female with small bowel obstruction due to herniation of a loop of intestine through a uterine defect with symptoms starting 63 days following manual vacuum aspiration.
Intra-abdominal or pelvic perforations usually present immediately which makes our case unique as the patient started having symptoms 63 days post manual vacuum aspiration. The most feared complication of prolonged small bowel obstruction is ischaemia which may lead to perforation. In our case, it is plausible that jejunum partially herniated into the uterine cavity shortly after manual vacuum aspiration, forming a jejunal plug, leading to the delayed onset of symptoms. This delay in onset of symptoms might have led to progressive massive dilatation of the small bowel and subsequent ischaemic necrosis.
Detailed history taking is pertinent as bowel obstruction could still occur a prolonged period after manual vacuum aspiration. A double-contrast enhanced CT scan of the abdomen proves invaluable in the context of surgical planning and facilitating the collaboration of a multidisciplinary team, particularly when the underlying causes of bowel obstruction remain elusive upon initial presentation.
粘连和外部疝是小肠梗阻最常见的两个原因。已知手动真空抽吸后腹腔或盆腔内器官穿孔会导致急性症状。
我们报告一例33岁女性，因一段肠管通过子宫缺损处疝出导致小肠梗阻，症状在手动真空抽吸63天后出现。
腹腔内或盆腔穿孔通常会立即出现症状，而我们的病例很独特，因为患者在手动真空抽吸63天后才开始出现症状。长时间小肠梗阻最可怕的并发症是缺血，可能导致穿孔。在我们的病例中，很有可能是空肠在手动真空抽吸后不久部分疝入子宫腔，形成空肠堵塞，导致症状延迟出现。症状出现的延迟可能导致小肠进行性大量扩张及随后的缺血性坏死。
详细的病史采集很重要，因为手动真空抽吸后很长一段时间仍可能发生肠梗阻。腹部双对比增强CT扫描在手术规划以及促进多学科团队协作方面具有重要价值，尤其是在肠梗阻初始表现时潜在病因仍不明确的情况下。
