Recurrent Severe Postpartum Abdominal Complications After Repeat Cesarean Delivery

Background:

•Cesarean delivery is associated with postoperative adhesions

•Small bowel obstruction (SBO) after cesarean is rare (~0.1%)

•Severe complications such as ischemia or bowel perforation

are poorly characterized

•Limited data on:

•Patient-level risk factors for SBO

•Predictors of progression to perforation

•Clinical challenge:

•Risk stratification is limited

•Complications often present late and severeKulkarni R, Bowel perforation - subdiaphragmatic free gas. Case study, Radiopaedia.org (Accessed

on 03 Apr 2026) https://doi.org/10.53347/rID-21444

Kristen Harris,1 Chelsea Fechter,2 Laura Sorabella1

1. Department of Anesthesiology, Vanderbilt University Medical Center, Nashville, Tennessee, 2. Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TennesseeCase: 31-year-old G3P3003 at 39w0d undergoing repeat cesarean delivery

• History:

•Two prior cesarean deliveries

•Both complicated by postoperative SBO requiring surgery

•Intraoperative finding:

•Small bowel adhesion to anterior abdominal wall

•Postoperative day 1:

•Abdominal distension, tachycardia, worsening pain

•Imaging: free intraperitoneal air

•Emergent laparotomy:

•Small bowel perforation at adhesion site

•Intact hysterotomy

•Underwent bowel resection and washout

•Course:

•ICU admission + acute kidney injury

•Discharged POD 8 Tulandi et al., Gynecol Surg, 2011 (Fig. 3)Teaching Points

• No clinical guidelines exist for risk stratification of SBO or delayed perforation after

cesarean delivery

• Limited risk stratification increases the likelihood of undetected clinical

progression to ischemia or perforation

• Cesarean-associated SBO may present with advanced pathology, requiring early

recognition and high postoperative vigilance