Hemostatic agent-related small-bowel obstruction following a cesarean delivery

Background: Gelatin materials function as hemostatic agents by tamponade and as structural networks for serum proteins and clotting products. We report a small-bowel obstruction associated with a gelatin hemostatic agent placed during a cesarean delivery. To our knowledge, no other reports of postoperative small-bowel obstruction associated with a gelatin hemostatic agent have been recorded. Case: A 37-year-old gravida 5, para 1031 underwent a primary cesarean section for placental abruption. A portion of Gelfoam® was placed on the uterine incision for additional hemostasis. The patient recovered as anticipated until postoperative day 2, when she reported significant abdominal pain and began experiencing recurrent bouts of emesis. A computed tomography scan of the abdomen and pelvis revealed a small-bowel obstruction. The patient failed to improve with conservative management and underwent exploratory laparotomy on postoperative day 7. Intraoperatively, a transition point was identified at an adhesion to the uterus, near the uterine incision. The adhesion was lysed and upon inspection, residual gelatin material was present on the uterus and on the affected area of small bowel. A full inspection of small and large bowel revealed no gastrointestinal injuries. Her postoperative course was unremarkable and she was discharged home on postoperative day eighteen. Conclusions: Small bowel obstruction following cesarean delivery is rare. We report the first documented incident of small bowel obstruction associated with the use of a gelatin hemostatic agent.