P2017 - Chronic Constipation and Small Bowel Obstruction as a Complication of Uterine Fibroids

Anna Thiemann, MD, Benjamin Yip, MD, Kevin O`Connor, MD
California Pacific Medical Center, San Francisco, CA

Introduction: Small bowel obstruction (SBO) is a common clinical condition, typically caused by adhesions, hernias or malignancy. However, extrinsic compression is an often-overlooked etiology. We present a rare case of chronic constipation and SBO caused by large uterine fibroids, underscoring the importance of comprehensive evaluation in patients with persistent gastrointestinal symptoms.

Case Description/

Methods: 47-year-old female with a history of uterine fibroids presents with chronic constipation. She was recently admitted to the hospital for small bowel obstruction, which was managed conservatively. Since discharge, she continued to have intermittent constipation and abdominal pain. Trials of lubiprostone and linaclotide did not provide relief. MRI revealed 4 large and at least 8 smaller leiomyomas. The largest leiomyomas measured 6 x 7 x 5 cm and led to severe sigmoid narrowing on MRI. Due to concern that uterine fibroids could be contributing to partial small bowel obstruction and constipation, she was referred to interventional radiology for uterine artery embolization (UAE), which improved her gastrointestinal symptoms.

Discussion: This case highlights a rare but important extrinsic cause of small bowel obstruction and chronic constipation due to mass effect from uterine fibroids. While fibroids are a common gynecologic condition, their presentation with gastrointestinal symptoms such as bowel obstruction is unusual and can lead to delays in diagnosis. UAE was successfully performed, leading to symptomatic relief and resolution of the obstruction without the need for surgical resection. This case underscores the importance of considering pelvic pathology in the differential diagnosis of bowel obstruction and chronic constipation in women and demonstrates the utility of UAE as a minimally invasive, fertility-sparing therapeutic option in select patients.


Figure: Uterine Fibroids Causing Sigmoid Narrowing


Figure: CT Coronal View Uterine Fibroids

Disclosures:
Anna Thiemann indicated no relevant financial relationships.
Benjamin Yip indicated no relevant financial relationships.
Kevin O`Connor indicated no relevant financial relationships.

Anna Thiemann, MD, Benjamin Yip, MD, Kevin O`Connor, MD. P2017 - Chronic Constipation and Small Bowel Obstruction as a Complication of Uterine Fibroids, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.