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Small Bowel Obstruction Post-Pregnancy


My husband and I are seeking advice and support as we recently went through a scary and discouraging time. I had my colon removed and J pouch/ileostomy formation in December of 2012, with my takedown in May of 2013. I did have a second unplanned surgery in between those two procedures due to an adhesion that formed while I was still in the hospital during my first surgery, resulting in a kink in my small bowel that wouldn’t allow stool to move through.

We were very fortunate to become pregnant on our very first try last August. My pregnancy went relatively well, other than the development of high blood pressure at about 24 weeks and a need for close monitoring and BP meds. I delivered via C section at 39 weeks, and other than a brief time where I had what they think was an ileus that resolved without intervention, all was well. I did end up back in the hospital 5 days post op with a throbbing headache and very high BP, which they think may have been postpartum pre-eclampsia (I was off my BP meds as my pressure completely normalized immediately following delivery). This all resolved and I have not been on BP meds since.

Then suddenly, at 7 weeks post partum, I developed a small bowel obstruction that resulted in almost a week with an NG tube and an open laparotomy 4 days in as they did not think it would resolve on its own. They found I had an adhesion (likely from my first surgeries) right near my old ileostomy site, and my small bowel was twisted around my mesentery at that spot. They informed me it never would have resolved without surgical intervention. 

Nobody can seem to give me any solid advice as to whether I am at very high risk of this same scenario happening again should we try for a second child. My OB told me that in her 27 years of practice, I am the first J pouch patient she’s ever had who has developed a SBO after pregnancy. The colorectal surgeons here in Milwaukee, WI feel that perhaps my uterus expanding and then shrinking back down to size resulting in my bowels shifting, allowing it to get twisted in that old adhesion. They did lyse that adhesion and ran my small bowel to look for others, but didn’t find any. I emailed my original surgeon at Mayo Clinic and she informed me pregnancy shouldn’t affect that and my risk of another SBO requiring surgery is less than 10%. The message across the board has been to weigh the risks and make the decision for ourselves, but medically and anecdotally there is no evidence to suggest we couldn’t try again if we wanted to take the risk. This is leaving us confused and conflicted, as this most recent surgery was frightening and very difficult to go through. Has anyone ever experienced these issues before? Any advice to help us make decisions? We are completely open to adoption, but are hesitant to close the door on another biological child completely until we thoroughly think this through. 

Thank you!

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