S6066 Chronic Constipation and Small Bowel Obstruction as a Complication of Uterine Fibroids

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: Forty-seven-year-old woman 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. Magnetic resonance imaging (MRI) revealed 4 large and at least 8 smaller leiomyomas. The largest leiomyomas measured 6 × 7 × 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.