Large bowel obstruction in a 27-year-old woman caused by a sigmoid faecal bolus

BMJ Case Reports
Radford Arran James SmithRobert Bethune

Abstract

A 27-year-old woman presented to the emergency department with a 24-hour history of severe left iliac fossa pain associated with vomiting. She reported a history of ovarian cysts and was provisionally diagnosed with a ruptured ovarian cyst and admitted under the obstetrics and gynaecology team for further investigation. 24 hours later, she became haemodynamically unstable with increasing abdominal distention and developed a metabolic acidosis. A CT scan revealed large bowel obstruction (LBO) secondary to a faecal bolus in the sigmoid colon with appearances suggestive of adult-onset Hirschsprung's disease. She underwent an emergency laparotomy and decompressive transverse colotomy and was admitted to the intensive care unit overnight. After discharge, she presented again with small bowel obstruction (SBO) which resolved with conservative management. A follow-up colonoscopy and biopsies showed no anatomical abnormalities to account for the LBO and were inconclusive for Hirschsprung's disease.

References

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Jul 22, 2015·The Korean journal of gastroenterology = Taehan Sohwagi Hakhoe chi·Jong Jin Lee, Jeong Wook Kim
Feb 15, 2017·BMJ Case Reports·Matthew Marget, Hussam Ammar
Feb 22, 2017·Revista Española De Enfermedades Digestivas : Organo Oficial De La Sociedad Española De Patología Digestiva·Guillermo Ontanilla ClavijoJuan Manuel Bozada García
Apr 18, 2018·GE Portuguese Journal of Gastroenterology·Gonçalo AlexandrinoJorge Reis

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