194 An uncommon cause of small bowel obstruction with perforation after a caesarean section

Abstract The incidence of small bowel obstruction after any abdominal surgery is 9%, whereas it only 0.1% a C-Section. Small secondary to herniation segment the beneath intact rectus sheath and between muscle extremely rare. Reviewing literature revealed that less than five cases were reported. Here we present 39-year-old female six days post caesarean section presented with abdomen pain, distension, not opening bowels. blood investigations showed White cells 15.42x109/L C-reactive protein 286mg/L. She was hypotensive tachycardic. On clinical examination, distended peritonitic. Computed tomography pelvis contrast there multiple loops proximal dilated transition point within in midline inferior umbilical or incisional hernia containing knuckle moderate amount pneumoperitoneum free fluid. underwent an emergency laparotomy found have four quadrants purulent peritonitis. In addition, 3cm defect peritoneum allowed approximately 30cm into preperitoneal space recti ischaemia perforation at neck hernia. had resection anastomosis, peritoneal formally closed prevent re-herniation loops. NICE guidelines recommend closing during c-section. However, this case example severe postoperative morbidity, which could be avoided by closure.