A colostomy or an ileostomy can be problematic during pregnancy because of its location (Hux, 2010). In a report of 82 pregnancies in 66 women with an ostomy, stomal dyfunction was common, but it responded to conservative management in most cases (Gopal, 1985). Surgical intervention was necessary, however, in three of six women who developed boweliobstruction and in another four with ileostomy prolapse-almost 10 percent overall. In this older study, only a third of 82 women underwent cesarean delivery, but Takahashi (2007) described six of seven cesarean deliveries in women with Crohn disease and a stoma. Although adhesions usually are involved with an obstructed ileostomy, the enlarging uterus may act to obstruct (Porter, 2014). Finally, Farouk and coworkers (2000) reported that pregnancy did not worsen long-term ostomy function.
The incidence of bowel obstruction is not increased during pregnancy, although it generally is more diicult to diagnose.
Meyerson (1995) reported a 20-year incidence of 1 in 17,000 deliveries at two Detroit hospitals. In one study, adhesive dis ease leading to small-bowel obstruction was the second most common cause of an acute abdomen in pregnancy following appendicitis-15 versus 30 percent, respectively (Unal, 2011). Approximately half of cases are due to adhesions from previous pelvic surgery that includes cesarean delivery (Al-Sunaidi, 2006; Andolf, 2010; Lyell, 2011). Another 25 percent of bowel obstruction cases are caused by volvulus-sigmoid, cecal, or small bowel. hese have been reported in late pregnancy or early puerperium (Bade, 2014; Biswas, 2006; l Maksoud, 2015). Small-bowel obstruction has been reported in pregnancy following the currently popular Roux-en-Y gastric bypass for weight loss (Bokslag, 2014; Wax, 2013). Intussusception is occasionally encountered (Bosman, 2014; Harma, 201l). Bowel obstruction subsequent to colorectal surgery for cancer was increased threefold in women who had open versus laparoscopic surgery (Haggar, 2013). Finally, Serra and colleagues (2014) described a massive ventral hernia with intestinal obstruction.
FIGURE 54-3 Characteristic "bent inner tube" seen with sigmoid volvulus on abdominal radiograph. (Reproduced with permission from Song LM, Topazian M: Gastointestinal endoscopy. Kasper
DL, Fauci AS, Hauser SL, et al (eds): Harrison's Principles of Internal Medicine, 19th ed. New York: McGraw-Hili Education; 2015.)