Date of Publication: 30-Nov--0001
Bowel Necrosis Due to Uterine Fibroids
Author: Mohamed Maliki-alaoui
Category: JMSR Surgery
A 37-year-old patient, with history of repeated miscarriages, referred to emergency for occlusive syndrome in pregnancy of 22 weeks. The onset of symptoms dates back to 5 days with diffuse abdominal pain, vomiting, bloating and no passing gas. The examination found a conscious patient, a 160 rate tachycardia, a stable blood pressure, a painful and tympanic abdomen. Abdominal ultrasound revealed bowel distension, a myomatous uterus and non-progressive pregnancy. Abdominal CT found small bowel distension and ischemia, peritoneal fluid and no transition-size zone. C-reactive protein was 102,10. The patient was operated after expulsion of a stillborn. Surgical findings were: small bowel distension, necrosis of the terminal ileum, polymyomatous uterus and an inflamatory bridle between a large necrotic fibroid and the underside of the mesentery of the ileal loops. We performed an ileocecal resection of 60cm and a double stomy. The postoperative course was simple after 48hours intensive care. Continuity restoration was performed a month later. The literature is full of papers explaining fibroids complications, but we didn’t find such a clinical presentation. Obstructive bowel over-distension results in parietal ischemia. Considering the absence of transition-size zone we can suggest that a progressive increase in uterine volume induced a compression or traction on the mesentery attached to the necrotic fibroid leading to necrosis of the corresponding territory.
Keywords: Bridle, bowel obstruction, necrosis, pregnancy, uterine fibroids