Small bowel obstruction due to congenital adhesion bands in the virgin abdomen. There is more than meets the eye

Abstract

INTRODUCTION: Adhesive small bowel obstruction (SBO) represents a common surgical emergency leading to increased hospital admissions. Most patients presenting with adhesive SBO have a history of previous abdominal surgery. Although bowel obstruction secondary to congenital adhesion bands is rare, it should not be ruled out even in patients with a “virgin abdomen”.

CASE REPORT: We present two rare cases of adult patients with SBO due to congenital adhesions. The first patient was transferred to the operating room, secondary to a closed-loop obstruction diagnosis. Two congenital adhesion bands were detected intraoperatively, then coagulated and divided. The second patient was surgically treated due to worsening abdom- inal pain. An adhesive band was identified occluding the ileum on surgical exploration, then ligated and excised. Both patients recovered uneventfully, without any recurrence of symptoms on the follow-up.

DISCUSSION: Single adhesive bands are more commonly found in cases with a “virgin abdomen”. Meanwhile, solitary bands usually lead to bowel strangulation and ischemia, mostly mandating operative management. Interestingly, a computed tomography scan may confirm the diagnosis of bowel obstruction, whereas water-soluble contrast agents may help predict the need for surgical treatment. Besides exploratory laparotomy, laparoscopic surgery is gaining ground as an effective SBO diagnosis and management approach.

CONCLUSION: Adhesive SBO due to congenital bands is a rare condition, particularly in adults, with potentially life- threatening complications. With the aim of prompt diagnosis and treatment, a high index of suspicion and awareness should be maintained even in patients without previous medical or surgical history.