P5108 - Unmasking the Unknown: A Case Series of Bowel Obstruction in the Virgin Abdomen and Its Surgical Imperatives

Nishmitha Puchakayala, MBBS¹, Balakrishnan Kamaraj, MBBS², Krishna Teja Vemulaghat, MBBS³, Sahithi Gopu, MBBS⁴, Deekshith Ameer Shaik, MBBS⁵, Bhavana Korlakunta, ⁶
1Osmania General Hospital and Medical College, Khammam, Telangana, India; 2Madurai Medical College, Vellore, Tamil Nadu, India; 3Osmania General Hospital and Medical College, Siddipet, Telangana, India; 4Osmania General Hospital and Medical College, Godhavarikhani, Telangana, India; 5Osmania General Hospital and Medical College, Hyderabad, Telangana, India; 6Osmania General Hospital and Medical College, Aswapuram, Telangana, India

Introduction: Bowel obstruction (BO) in patients with no prior abdominal surgery—termed obstruction in the “virgin abdomen” (VA)—remains a diagnostic and therapeutic dilemma. Though surgical exploration is often reserved for recurrent or post-operative cases, the etiology of BO-VA is frequently underreported, with potentially serious consequences if left untreated.

Case Description/

Methods: This retrospective case series reviews 25 patients presenting with BO-VA at a tertiary care center over two years. All patients underwent contrast-enhanced CT (CECT), with surgical management tailored based on clinical and imaging findings. Etiologies, intraoperative findings, histopathology, and postoperative outcomes were documented.

Discussion: Tuberculosis was the most common cause (24%), followed by malignancy, internal hernias, and congenital bands. Preoperative diagnosis was achieved in only 56% of cases; the rest were clarified intraoperatively. Notably, six patients with tubercular strictures and masses had features mimicking malignancy, highlighting the diagnostic ambiguity. All patients underwent laparotomy; none had major postoperative complications, emphasizing the safety and diagnostic value of early surgical intervention. This study underscores the need to consider early operative exploration in BO-VA to prevent delayed diagnosis and adverse outcomes.

Disclosures:
Nishmitha Puchakayala indicated no relevant financial relationships.
Balakrishnan Kamaraj indicated no relevant financial relationships.
Krishna Teja Vemulaghat indicated no relevant financial relationships.
Sahithi Gopu indicated no relevant financial relationships.
Deekshith Ameer Shaik indicated no relevant financial relationships.
Bhavana Korlakunta indicated no relevant financial relationships.

Nishmitha Puchakayala, MBBS¹, Balakrishnan Kamaraj, MBBS², Krishna Teja Vemulaghat, MBBS³, Sahithi Gopu, MBBS⁴, Deekshith Ameer Shaik, MBBS⁵, Bhavana Korlakunta, ⁶. P5108 - Unmasking the Unknown: A Case Series of Bowel Obstruction in the Virgin Abdomen and Its Surgical Imperatives, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.