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Obstructed ileostomy in the third trimester of pregnancy due to compression from the gravid uterus: diagnosis and management

Ileostomy obstruction in pregnancy, although rare, is a significant complication with associated morbidity and mortality. Early studies recommended immediate surgical intervention for cases of ileostomy obstruction in pregnancy. We present a case of ileostomy obstruction at 29-week gestation in which a laparotomy was performed for presumed adhesions. When adhesiolysis failed to resolve the obstruction, it became clear that the obstruction was caused by external compression from the enlarging gravid uterus. The remainder of the pregnancy was successfully managed by daily aspiration of bowel contents using a large bore drainage tube, and total parental nutrition. Recent studies have utilised MRI to distinguish between adhesions and uterine compression as the cause of ileostomy obstruction in pregnancy. In the few cases of obstruction caused by uterine compression, patients have been safely managed with conservative therapy, thereby avoiding the risks of surgery.