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Gastric Outlet Obstruction Caused by Gravid Uterus

Paleti, Swathi MD1; Petty, Lloyd MD2; Rustagi, Tarun MD1

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doi: 10.14309/crj.0000000000000314
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CASE REPORT

Intestinal obstruction in pregnancy has an incidence ranging from 1 in 1,500 to 1 in 66,500 and occurs most commonly during the third trimester when the gravid uterus rises into the abdomen.1 The most common causes for intestinal obstruction in pregnancy include adhesions from previous surgeries or cesarean births, intussusception, malignancy, and hernias.2 We present a case of gravid uterus causing gastric outlet obstruction without any of the earlier mentioned risk factors.

A 34-year-old woman, G9P6026 at 35 weeks, with no significant medical or surgical history presented with a 2-day history of nausea, dry heaving, and dull epigastric pain. She was not on any medications and denied the use of any nonsteroidal anti-inflammatory drugs. Physical examination was significant for distended abdomen with a gravid uterus along with mild tenderness to palpation in the epigastric region. Laboratory evaluation was unremarkable. Abdominal computed tomography obtained in the emergency department showed a large gravid uterus resulting in compression of the distal stomach and duodenum leading to marked gastric distension, consistent with gastric outlet obstruction (Figure 1). No other lesion or source of obstruction was noted. The patient was managed conservatively with nasogastric tube decompression with significant improvement in her symptoms. She was discharged after 2 days on a full liquid diet, which she tolerated well, and her symptoms completely resolved after the delivery of her baby 4 weeks later. An esophagogastroduodenoscopy was performed a few months later, which was normal including random gastric biopsies.

Figure 1.
Figure 1.:
Abdominal computed tomography showing a large gravid uterus.

DISCLOSURES

Author contributions: S. Paleti and L. Petty wrote the manuscript and revised the manuscript for intellectual content. T. Rustagi approved the final version and is the article guarantor.

Financial disclosure: None to report.

Informed consent was obtained for this case report.

REFERENCES

1. Perdue P, Jhonson H, Stafford P. Intestinal obstruction complicating pregnancy. AM J Surg. 1992;164:384–8.
2. Connolly M, Until J, Nora P. Bowel obstruction in pregnancy. Surg Clin North AM. 1995;75:101–13.
© 2020 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of The American College of Gastroenterology.