Small Bowel Obstruction as a Complication of Uterine Fibroids: A Case Report

Uterine fibroids are a common, benign gynecological smooth muscle neoplasm highly prevalent in women of reproductive age which can lead to multiple complications including small bowel obstruction. We report a case of a 31-year-old female, primigravida at 13 weeks gestation, a known case of uterine subserosal fibroids who presented to the emergency with complaints of dark red vaginal bleeding and cramping abdominal pain. On examination, her abdomen was 38 weeks in size. An abdominal ultrasound showed intrauterine retained products of conception measuring 5x5 cm. She was admitted as a case of incomplete miscarriage and underwent an evacuation of retained products of conception (ERPOC) immediately. A post-procedure computed tomography (CT) scan done showed the presence of multiple large uterine fibroids. The patient continued to worsen clinically with complaints of abdominal pain and diarrhea. Further laboratory tests revealed a continuous rise in inflammatory markers with positive stool clostridium toxins. She was hence shifted to the intensive care unit (ICU) as a case of sepsis. In the following days, she developed signs and symptoms of small bowel obstruction, and the diagnosis was supported by abdominal X-rays. Despite starting her on conservative management for the same, she deteriorated clinically, and a repeat CT abdomen showed new signs of small bowel obstruction. The gynecology team performed an exploratory laparotomy during which a myomectomy was done. The patient recovered well post-operatively and was discharged in a stable condition. In view of the presented case, small bowel obstruction should be considered as a complication of uterine fibroids in females with a history of large leiomyomas despite it being quite rare as it can cause considerable morbidity and mortality.