Adynamic ileus after Caesarean section mimicking intestinal obstruction: findings on abdominal radiographs

The purpose of this study was to determine the spectrum of findings and the frequency of apparent distal colonic obstruction on abdominal radiographs in women with obstructive symptoms following Caesarean section. A search of radiology files yielded 21 patients who had abdominal radiographs because of obstructive symptoms during the early post-operative period. The radiogr aphs were reviewed retrospectively to characterize the bowel gas patterns i n these patients. Medical records were also reviewed to determine the treat ment and patient course. abdominal radiographs showed findings suggestive o f distal colonic obstruction in 15 patients (71%), small bowel obstruction in 2 (10%), adynamic ileus in 3 (14%) and a normal bowel gas pattern in 1 ( 5%). In all 15 patients with apparent distal colonic obstruction, there was minimal or no gas in the rectosigmoid, with an associated pelvic mass repr esenting the enlarged post-partum uterus, which compressed the rectosigmoid and prevented it from filling with gas. All 21 patients had rapid clinical or radiographic improvement on conservative management, indicating a trans ient post-operative ileus. Radiologists should be aware of the limitations of abdominal plain radiographs following Caesarean section so that a post-o perative ileus is not mistaken for a distal colonic obstruction and conserv ative measures can be undertaken to decompress the bowel until the ileus re solves.