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Introduction Small bowel obstruction in pregnancy continues to be a rare and dangerous presentation, with the potential for fatal outcomes to both mother and foetus. As of yet, there is no consensus of management for this condition. Objective We describe the case of a 40 year old IVF twin DCDA primigravida pregnancy, who presented at 20 weeks with abdominal pain and vomiting. Past surgical history included myomectomy. She was found to have small bowel obstruction and necrosis secondary to a congenital peritoneal band. Methods A review of existing literature was conducted using several databases to compare previous management of similar conditions. Results The patient presented with epigastric pain, nausea and vomiting. On examination she was haemodynamically stable and both foetal heartbeats were heard. Initial management was medical, with intravenous fluids, anti-emetics and analgesia. Both pain and nausea worsened over 3 days. Abdominal ultrasound found prominent static bowel consistent with obstruction and the patient was referred urgently to the general surgeons. Further MRI confirmed the diagnosis. She underwent an emergency laparotomy, resection of small bowel (30 cm) and primary anastomosis. Recovery was complicated by post-operative ileus managed conservatively. She was discharged to complete a course of dalteparin during pregnancy and 6 weeks post-partum. The pregnancy continued to full term, delivering via elective C-section without issue at 37 weeks. Discussion Abdominal pain within pregnancy can offer a wide breadth of differentials and obstruction can be difficult to recognise. A low threshold for alternative diagnoses must therefore be kept for these examples. Equally, urgent imaging is key. Although contemporary management favours magnetic resonance (MR) imaging in order to minimise the effects of radiation on the foetus, organisation of this should not delay diagnosis and treatment. Ultrasound can be a useful alternative. Close partnership between surgical teams is also paramount.

Introduction Deep vein thrombosis (DVT) is the leading cause of morbidity and mortality within pregnant and post-partum women. Contemporary management of acute ilio-femoral DVT includes catheter-directed thrombolysis and stenting of an obstructive lesion. Objective This study examines venous stent related outcomes of peripartum women (pregnant or within 6wks post-partum) with acute ilio-femoral DVT. Methods Peripartum women (2012–2017) treated for acute ilio-femoral DVT were included for analysis. Primary patency was defined as a patent stent with Results Of 190 patients treated for acute ilio-femoral DVT, 81 (43%) were women. Cumulative patency was 88% (median follow-up 2.3 yrs; range 30–328 wks). From this group, 9 women were peripartum (11%). Onset of DVT was post-partum for all (mean 4 wks after birth; range 3–6 wks). Two women were treated with catheter-directed thrombolysis alone, and 7 women were also stented. Median age at the time of stent placement was 29yrs (range 22–41 yrs). Primary, primary-assisted, and secondary patency rates were 14%, 43%, and 43%, respectively. Re-intervention was required in 6/7 (86%) peripartum women, with mean time to re-intervention of 9 wks (range 1–33 wks). Venous stenting in peripartum women was associated with a higher risk of re-intervention (HR 6.58; p = 0.0001, 95% CI [2.46, 17.60]), and was a strong predictor of cumulative patency loss (HR 10.71; p = 0.002, 95% CI [2.37, 48.51]). Discussion Peripartum women are significantly more likely to require re-intervention and experience patency loss compared with their non-peripartum counterpart. Thresholds for intervention may need to be higher and periprocedural anticoagulation strategies require more investigation if treatment is to be offered in the peripartum period.