A rare postpartum bowel emergency left surgeons facing a dangerous intestinal knot
A 30 year old woman in Ethiopia developed a life-threatening bowel obstruction three days after giving birth, with doctors discovering an unusually rare knot involving her small and large intestines.
Her symptoms worsened after childbirth
The woman had delivered a healthy baby boy in an uncomplicated vaginal birth. During the following three days, her condition changed rapidly.
She developed worsening abdominal cramps, increasing swelling and repeated vomiting. She also could not pass stool or gas, signs that suggested her intestines were no longer moving contents normally.
By the time she arrived at the University of Gondar hospital, she was critically ill and severely dehydrated. Her blood pressure could not initially be measured, while her neck pulse was 160 beats per minute.
Doctors immediately began replacing lost fluids through intravenous treatment. After receiving four liters of saline, her blood pressure improved to 95/65 mmHg and her wrist pulse dropped to 112 beats per minute.
An abdominal X-ray showed enlarged loops of bowel, but it did not reveal the exact cause of the blockage. A CT scan could have offered more detail, but the hospital’s scanner was unavailable. Because her condition was deteriorating, doctors proceeded with emergency surgery.
Surgeons discovered an unusual intestinal knot
The cause became apparent when the surgical team opened her abdomen.
A section of her small intestine had wrapped around the lower portion of her large intestine, creating a tightly twisted knot. The configuration had obstructed intestinal contents while also cutting off blood flow.
The lack of circulation had severely damaged the trapped tissue. Part of the large intestine and about 60 centimeters, or nearly 24 inches, of small intestine had died. Surgeons also found roughly three liters of blood stained fluid in her abdomen.
As the knot tightens, it can block the bowel and restrict circulation at the same time. Without enough blood flow, intestinal tissue can deteriorate and allow bacteria and other substances to move beyond the gut.
The surgeons removed the damaged sections and reconnected the remaining large intestine. They also temporarily brought the end of the small intestine through an opening in the abdomen so waste could be collected externally.
The woman recovered after emergency treatment
Despite the severity of the obstruction, the woman survived. She was discharged six days after surgery and later returned for another operation to close the temporary opening. Follow up examinations found no reported complications.
The case also helped researchers consider why her intestines were able to twist. Anatomical differences can make some people’s intestines more mobile than others.
The surgeons found that she had a longer supporting membrane attached to the small intestine and a lower portion of the large intestine connected at a relatively narrow point. Those features may have provided enough movement for the intestinal sections to wrap around one another.
Previous research has suggested that a large meal following a long period without eating could contribute to this type of intestinal twisting. However, the case report did not identify a large meal as a trigger for this woman.
Pregnancy may have played an uncertain role
Pregnancy can change digestion and slow intestinal movement, while hormonal shifts may also increase constipation. Still, researchers could not determine whether pregnancy or delivery directly caused the intestinal knot.
The woman did not have a history of constipation or neurological or psychiatric conditions. The case authors considered her immediate postpartum period and the high fiber diet common in her region as possible contributing factors, but a single case cannot establish a direct cause.
The condition is exceptionally rare. Most reported patients have been men, and the authors found only about 15 reported cases during pregnancy between 1967 and 2025, with even fewer cases occurring after childbirth.
For new mothers, ordinary abdominal discomfort does not mean an intestinal knot is developing. However, worsening abdominal pain, swelling, repeated vomiting and an inability to pass stool or gas can signal a bowel obstruction and warrant prompt medical attention.
Because an intestinal knot can resemble other forms of obstruction, identifying it can be difficult. Some types of bowel twisting may be treated without surgery, but those approaches may be unsafe when blood flow has already been severely restricted.
The case highlights why worsening digestive symptoms after childbirth should not automatically be attributed to routine postpartum changes. Rare complications can require urgent evaluation and treatment.
