This is a 30-year-old patient, 36 weeks pregnant, with a history of laparotomic biliary pancreatic bypass (Scopinaro) performed nine years earlier (presurgical BMI 48, abdominal cr
Once the symptoms reappeared, the patient returned to the emergency room again due to abdominal pain of similar characteristics, at the hypogastric level, accompanied by vomiting, without fever and few hours of evolution.
Physical examination revealed diffuse abdominal pain without peritonitis, mainly in the lower hemiabdomen.
Blood tests showed intense leukocytosis (28,500 leukocytes/ml, 89,2 % neutrophils), CRP 18,4 mg/dl, procalcitonin 3,2 ng/ml and Quick index of 58 %.
Although fetal monitoring does not describe signs of suffering, it was decided to induce labor in case of clinical suspicion of acute pyelonephritis ( given the recent history of the patient).
The delivery was uneventful and a healthy 2800-g girl was born vaginally.
On the following day, suspecting removal of the epidural catheter and suppression of continuous intravenous analgesic infusion, the patient developed hyperacute abdominal pain with marked signs of peritoneal irritation.
An abdominal-pelvic CT scan showed a pneumoperitoneum with free fluid, as well as diffuse thickening and distension of the intestinal loops.
The patient underwent emergency surgery, which showed purulent pelviperitonitis following intestinal perforation due to burst of a common anastomosis to the ileo-ileal wall of the ascitic arch of the S.
Primary closure of the perforation and abdominal lavage were performed.
The postoperative course was satisfactory without complications.
