Subacute small bowel obstruction in a twin pregnancy: a diagnostic and management challenge

Abstract Small bowel obstruction (SBO) in pregnancy is rare but serious, presenting a diagnostic challenge due to symptom overlap with common gestational conditions and hesitancy around radiologic imaging. We describe a case of progressive, subacute SBO in a 46-year-old woman with dichorionic diamniotic twins and a history of caesarean section. The case culminated in bowel perforation, emergency laparotomy, and preterm delivery. This case highlights the need for early recognition, appropriate imaging, and multidisciplinary management to minimize maternal and foetal morbidity.