{"paper_id":"6b9702b7-aeaf-4fda-b441-c9dcc457bb2a","body_text":"Case Reports in Clinical Medicine, 2026, 15(3), 69-74 \nhttps://www.scirp.org/journal/crcm \nISSN Online: 2325-7083 \nISSN Print: 2325-7075 \n \nDOI: 10.4236/crcm.2026.153009  Feb. 28, 2026 69 Case Reports in Clinical Medicine \n \n \n \n \nUterine Tube Encircling Small Bowel Causing \nMechanical Obstruction, Case Report and \nLiterature Review \nMuhaned Alhassan1, Ayman Bargash1,2, Hatem Al Saadi1, Asma Al Kahali1, Ruqiaya Al Mamari2,  \nRazan Ahmed3 \n1General Surgeons Sohar Hospital, Sohar, Oman \n2Consultant General, Upper GI and Bariatric Surgeon, As Sewaq Hospital, Sewage, Oman \n3Sohar Hospital, Sohar, Oman \n \n \n \nAbstract \nIntroduction: Intestinal obstruction is one of the common presentations of \npatients with acute abdomen to the Surgical Emergency Department, and it is \nassociated with significant morbidity and mortality. The most common causes \nof acute small bowel obstruction are adhesions and an obstructed hernia. One \nof the rare causes of acute small bowel obstruction is constriction of bowel wall \nby fallopian tubes, and it usually occur s secondary to adhesions of previous \nobstetric and gynecological surgeries. Other gynecological causes include en-\ndometriosis and Pelvic inflammatory diseases. Case Presentation: We are pre-\nsenting a 56-year-old married female, who is presented with features of acute \nmechanical intestinal obstruction for duration of two days. She had a history \nof Caesarian Section, however, no other significant history. CT scan abdomen \nconfirmed the clinical finding and showed closed loop small bowel obstruc-\ntion with radiological signs of mesenteric ischemia. Diagnostic lap aroscopy \nwas done, and the intraoperative finding was constriction band formed by left \ntube causing obstruction of ileal loop segment and intestinal obstruction. Dis-\ncussion: One of the rare causes of mechanical small bowel obstruction is  gy-\nnecological causes like endometriosis, internal hernia or like in our case fallo-\npian tube adhesions causing a constriction band. The intraoperative decision \nis challenging and often required skillful laparoscopic surgeon in order to \nminimize morbidity and preserve the functioning tube. \n \nKeywords \nSmall Bowel Obstruction, Fallopian Tubes, Gynecological, Colicky, CT-Scan,  \nCesarean Section \nHow to cite this paper : Alhassan, M., Bar-\ngash, A., Al Saadi, H., Al Kahali, A., Al Ma-\nmari, R. and Ahmed, R. (2026) Uterine \nTube Encircling Small Bowel Causing Me-\nchanical Obstruction, Case Report and Lit-\nerature Review. Case Reports in Clinical \nMedicine, 15, 69-74. \nhttps://doi.org/10.4236/crcm.2026.153009 \n \nReceived:  August 20, 2025 \nAccepted: February 25, 2026 \nPublished:  February 28, 2026 \n \nCopyright © 2026 by author(s) and  \nScientific Research Publishing Inc. \nThis work is licensed under the Creative \nCommons Attribution International  \nLicense (CC BY 4.0). \nhttp://creativecommons.org/licenses/by/4.0/   \n  \nOpen Access\n\nM. Alhassan et al. \n \n \nDOI: 10.4236/crcm.2026.153009 70 Case Reports in Clinical Medicine \n \n1. Introduction \nIntestinal obstruction is one of the common causes of acute abdominal pain with \nincreased morbidity and mortality. Moreover, the most common causes are adhe-\nsions and obstructed hernia [1]. \nFemale pelvic organs, including tubes, uterus, and ovaries can cause adhesive \nobstruction of small bowel specially ileum and distal jejunum. One of the rare \ncauses of acute small bowel obstruction is constriction of bowel wall by fallopian \ntubes [2]. The causes are usually due to adhesive process following inflammation, \ninfection or prior pelvic surgery [3].\n Other gynecological causes include endome-\ntriosis and Pelvic inflammatory diseases [4]. The presentation is usually with car-\ndinal features of bowel obstruction, especially vomiting and abdominal pain. \nDiagnosing rare causes of bowel obstruction pre- operatively remains a chal-\nlenge. Radiological imaging, particularly contrast-enhanced CT, can delineate the \nsite and degree of obstruction but often fails to identify the exact etiology when it \ninvolves small pelvic structures such as the uterine adnexa [ 5]. Consequently, \nmany of these conditions are discovered incidentally during surgical exploration, \nemphasizing the need for maintaining a high index of suspicion for gynecological \ncauses in women of reproductive or postmenopausal age. \nThe morbidity and mortality are usually having a direct relationship with de-\nlayed surgical intervention and diagnosis. \nWe are presenting one of the rare causes of mechanical intestinal obstruction \ndue to encircling of small bowel by fallopian tube causing occlusion of bowel lu-\nmen and mechanical obstruction. \n2. Case Presentation \nA 56-year-old female with past history of Cesarean Section 20 years ago. \nShe presented to the Emergency Department complaining of severe central col-\nicky abdominal pain, radiated to all over her abdomen , and bilious vomiting for \ntwo days. Also, she experienced absolute constipation and abdominal distention \nfor one-day duration. No fever, weight loss or other GI symptoms. \nNo chronic illness, and no previous similar conditions \nOn the examination, she looks dehydrated, afebrile, conscious and oriented. \nHer BP is 100/70 mmHg , Pulse rate is 110 P/M. Abdominal examination re-\nvealed, distended abdomen with vague tenderness all over , no palpable mass , \nbowel sound was exaggerated and rectum was empty on digital rectal examina-\ntion. \nInvestigations: her WBCs was 13,000, Hb: 10.3 g/dl. RFT & LFT were normal. \nABG was normal. Abdomen X-ray revealed dilated small bowel loops with air flu-\nids level. CT scan abdomen revealed features of high -grade small bowel obstruc-\ntion with closed loop obstruction. However, the bowel wall was well enhanced and \nno radiological evidence of bowel ischemia. \nTreatment: The patient was admitted for monitoring, and was started on intra-\nvenous hydration, nothing by mouth and nasogastric decompression. Decision \n\nM. Alhassan et al. \n \n \nDOI: 10.4236/crcm.2026.153009 71 Case Reports in Clinical Medicine \n \nwas made for laparoscopic exploration she was taken to Operation theater after \nresuscitation and written informed consent. The distended bowel obscures the \nfield, thus the decision to convert to open was made. The finding was obstruction \nat terminal ileum caused by right fallopian tube causing constriction band with \nmesentery adhesion (Figure 1 ), proximal bowel dilatation with signs of strangu-\nlation and distal collapsed bowel (Figure 2 ). \nAdhesions was released and preserved the right uterine tube and small bowel \nsegment. \n \n \nFigure 1 . A band formed by fallopian tube with proximal small bowel obstruction. \n \n \nFigure 2 . Dusky proximal small bowel segment with tube causing constriction ring and \nadhesions. \n\n\nM. Alhassan et al. \n \n \nDOI: 10.4236/crcm.2026.153009 72 Case Reports in Clinical Medicine \n \n3. Discussion \nAlthough there are several causes for acute mechanical small bowel obstruction , \nthe commonest causes among them are adhesions , and obstructed hernia. How-\never, other causes like malignancy (lymphoma, adenocarcinoma), abdominal tu-\nberculosis and volvulus remain not uncommon [1]. \nSmall bowel obstruction can be caused by adhesive bands, or rarely by fallopian \ntube encircling the segment of small bowel and forming constricting bands like \nobstruction [2]. \nThe mechanism of obstruction by the fallopian tube is thought to involve post-\noperative adhesion of the tube to the bowel mesentery,  leading to entrapment or \nlooping of a bowel segment within a fibrous band. Such adhesive processes may \ndevelop following prior pelvic surgery, inflammation, or infection, resulting in a \nconstricting mechanism that compromises bowel lumen patency [3]. \nIn the literatures there are a few cases reported for acute intestinal obstruction \ncaused by fallopian tube adhesions and most of the cases occur in middle age \ngroup with previous history of surgeries [4]. \nOne of the rare gynecological causes of intestinal obstruction is endometriosis \ncan cause either adhesion of implantation into serosal wall of small bowel with \npresentation of cardinal features of intestinal obstruction [6]. \nVery rarely endometriosis can cause large bowel obstruction with complete oc-\nclusion of rectosigmoid junction [6]. \nOur patient presented with high grade mechanical small bowel obstruction with \ncomplete occlusion of terminal ileum in a patient with a previous history of cesar-\nean section which is one of the few cases reported in the literature as a rare cause \nof mechanical small bowel obstruction. \nA review of similar cases in the literature highlights the rarity of this condition. \nFor instance,\n Bugmann et al. and Cameron et al. reported isolated cases where \nfallopian tubes entrapped bowel segments , resulting in obstruction. These find-\nings emphasize the importance of considering gynecological etiologies in women \nof reproductive or postmenopausal age presenting with unexplained SBO , espe-\ncially with prior pelvic surgery history [5]. \nRadiological imaging, particularly CT scan, is invaluable in diagnosing the level \nand severity of obstruction but may fail to identify the exact etiology when related \nto small pelvic structures such as the fallopian tubes  [7]. The typical features in-\nclude the “C-loop” or “whirl sign,” which indicate torsion or closed-loop obstruc-\ntion. However, gynecologic causes are rarely apparent on imaging, and definitive \ndiagnosis often requires diagnostic laparoscopy or laparotomy [7]. \nDiagnostic laparoscopy has become an essential tool in the assessment of small \nbowel obstruction, particularly when the etiology is uncertain or when a gyneco-\nlogical cause is suspected [7]. It provides direct visualization of the peritoneal cav-\nity, allowing both diagnosis and therapeutic intervention in selected patients [8]. \nHowever, in patients with markedly distended bowel loops or dense adhesions, as \nin the present case, conversion to open surgery may be necessary to prevent iat-\n\nM. Alhassan et al. \n \n \nDOI: 10.4236/crcm.2026.153009 73 Case Reports in Clinical Medicine \n \nrogenic injury [9]. \nTimely surgical intervention remains a critical determinant of outcome in pa-\ntients with mechanical small bowel obstruction [ 10] [11]. Several recent studies \nhave shown that diagnostic and operative delays beyond 24 to 48 hours are asso-\nciated with significantly increased rates of bowel ischemia, perforation, sepsis, and \nmortality [11]. Moreover, delayed intervention often results in higher rates of \nbowel resection and prolonged recovery,  particularly in elderly patients or those \nwith multiple comorbidities. Therefore, maintaining a high index of suspicion and \nproceeding with early exploration when clinical or radiological findings suggest \nhigh-grade obstruction is essential to improving patient survival and minimizing \nmorbidity [12]. \n4. Conclusions \nThis case underscores the importance of maintaining a broad differential diagno-\nsis in women presenting with features of small bowel obstruction , particularly \nthose with a history of cesarean or pelvic surgery. \nEarly surgical intervention may be necessary in certain situations if clear diag-\nnosis is uncertain , especially for patients with high- grade mechanical intestinal \nobstruction to decrease morbidity and mortality. \nOne of the rare causes of mechanical bowel obstructions is a gynecological pa-\nthology like endometriosis and fallopian tube encircling small bowel and requires \nhigh index of suspicion. \nRadiological diagnosis usually failed to identify fallopian tubes as causes of me-\nchanical bowel obstruction. \nSurgical release of adhesions and preservation of both small bowel and tubes is \na goal to avoid gynecological morbidity and surgical mortality. \nConflicts of Interest \nThe authors declare no conflicts of interest regarding the publication of this paper. \nReferences \n[1] Hayanga, A.J., Bass-Wilkins, K. and Bulkley , G.B. (2005) Current Management of \nSmall-Bowel Obstruction. Advances in Surgery, 39, 1-33.  \nhttps://doi.org/10.1016/j.yasu.2005.05.001  \n[2] Cameron, M., Janakan, G., Birch, D. and Nazir, S. (2015) A Closed Loop Obstruction \nCaused by Entrapment of the Fallopian Tube and Herniation through the Broad Lig-\nament. International Journal of Surgery Case Reports, 12, 57-59.  \nhttps://doi.org/10.1016/j.ijscr.2015.02.010  \n[3] Lam, K. and Lang, E. (2020) Endometriosis as a Rare Cause of Small Bowel Obstruc-\ntion. ANZ Journal of Surgery, 90, E137-E138. https://doi.org/10.1111/ans.15916  \n[4] Arafat, S., Alsabek, M.B., Almousa, F. and Kubtan, M.A. (2016) Rare Manifestation \nof Endometriosis Causing Complete Recto-Sigmoid Obstruction. International Jour-\nnal of Surgery Case Reports, 26, 30-33. https://doi.org/10.1016/j.ijscr.2016.07.004 \n[5] ten Broek, R.P.G., Krielen, P., Di Saverio, S., Coccolini, F., Biffl, W.L., Ansaloni, L., et \n\nM. 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Annals of Surgery, 271, 1081-1088.  \n[12] Loftus, T.J., Efron, P.A., Bala, T.M., et al. (2019) Timing of Surgical Intervention for \nSmall Bowel Obstruction: An American College of Surgeons NSQIP Analysis. Journal \nof Trauma and Acute Care Surgery, 87, 144-153.","source_license":"CC0","license_restricted":false}