Early ileal perforation with fecal peritonitis secondary to adhesive small bowel obstruction after repeat cesarean section: a case report.

Adhesive small bowel obstruction (ASBO) in the immediate postpartum period is uncommon and may mimic postoperative ileus. A 26-year-old woman returned 48 hours after repeat cesarean section with abdominal distension, vomiting, and obstipation. Her history included a previous cesarean delivery and prior midline laparotomy for ovarian torsion with appendectomy and right salpingo-oophorectomy. Radiography showed dilated small-bowel loops with air-fluid levels, without initial peritoneal signs. After nasogastric decompression and observation, she deteriorated ~10 hours later with worsening pain, peritoneal signs, hypotension, tachypnea, and hypoxemia. Repeat imaging demonstrated pneumoperitoneum and complex intraperitoneal fluid. Emergency laparotomy revealed dense ASBO, generalized fecal peritonitis, and ileal perforation 20 cm proximal to the ileocecal valve. Segmental ileal resection with end ileostomy was performed. She required 5 days of intensive care. Ileostomy reversal 5 months after discharge was uncomplicated, with no major complications at 3-month follow-up.