Objectives: Abdominal pain in pregnancy can be due to gynaecologic, gastrointestinal, genitourinary or vascular disorders. It is challenging to diagnose a gastrointestinal pathology in a pregnant woman due to physiological changes occurring in pregnancy. Bowel obstruction due to adhesion band in pregnancy is rare. A thorough history taking, clinical examination, investigations and imaging modalities can help in diagnosis. Nevertheless, surgical evaluation and intervention is the hallmark in treatment.

Methods: We present a rare case of small bowel obstruction due to adhesion band in a pregnant lady.

Case Report: A primigravida at 29 weeks gestation presented with abdominal pain and vomiting. She was diagnosed with acute gastritis and treated accordingly. She had had an appendicectomy 10 years previously. The following day her symptoms hadn’t resolved. The abdominal ultrasound revealed a probable loop obstruction of the small bowel. The surgical team proceeded with exploratory laparotomy. Intraoperative findings were a close loop small bowel obstruction by adhesion band situated near the duodenojejunal junction. There was 1 litre of haemorrhagic peritoneal fluid. The bowel had a dusky appearance; however responded to bowel resuscitation with warm pack. The other structures were normal. She was managed conservatively and the pregnancy continued. On the 12^th post-operative day, she delivered a healthy baby girl vaginally. Unfortunately, she developed similar symptoms and imaging by ultrasound and CT scan of the abdomen suggested bowel obstruction and significant free fluid. A second exploratory laparotomy revealed presence of 1.5 litres of bilious fluid, food particles and slough. There were multiple perforations over the ileum, 10 cm away from the ileocaecal junction. A total of 40 cm of small bowel was resected and a double barrel stoma was created from the caecum and ileum. Post operatively patient’s condition was complicated by necrotizing fasciitis of the anterior abdominal wall. She had a stormy recovery period requiring multiple wound debridements and revisions of the Bogota bag. She was discharged home after 2 months.

Conclusion: Bowel obstruction due to adhesion band in pregnancy is rare, but can result in significant maternal morbidity.