Spontaneous Intestinal Perforation in Pregnancy from a Pre-Existing Postoperative Adhesion: A Case Report

BACKGROUND: Spontaneous intestinal perforation is rare in pregnancy. Previously described cases have been associated with endometriosis, Crohn's disease, and intestinal tuberculosis. CASE: We describe a case of spontaneous intestinal perforation in pregnancy from a postoperative adhesion. The patient presented with multiple episodes of abdominal pain and vomiting starting at 255 weeks. The diagnosis was made at 28 weeks when she presented with severe pain and abnormal fetal heart rate requiring emergency cesarean section with bowel resection. CONCLUSION: This case demonstrates that adhesions between the bowel and uterus from prior surgery may lead to spontaneous intestinal perforation as the uterus enlarges during pregnancy. As this diagnosis can be difficult because of imaging limitations and physiologic changes of pregnancy, it should be considered in cases of unremitting abdominal pain and vomiting.