Question

A pregnant female had Meconium stained liquor and underwent emergency LSCS. A few days later her condition deteriorated. USG showed edematous bowels. What's the cause ?

• A. Meconium peritonitis
• B. Paralytic ileus
• C. Adhesive intestinal obstruction
• D. Intra-abdominal abscess

Answer 1

The Correct Option is B

Clinical pearl: a deteriorating mother a few days post-LSCS with USG showing swollen, fluid-filled bowel loops is the classic picture of an adynamic (paralytic) ileus, the most frequent bowel complication after caesarean handling and peritoneal irritation.

Eliminate by feature: Meconium peritonitis is a disease of the fetus or newborn (sterile chemical peritonitis from antenatal gut perforation), so it cannot be the mother's diagnosis. Adhesive intestinal obstruction is mechanical with hyperactive then absent sounds and tends to appear weeks to months later, not in the immediate postoperative window. An intra-abdominal abscess presents with spiking pyrexia, tachycardia and a localized tender collection rather than generalized bowel edema.

That leaves paralytic ileus: peristalsis fails, gas and fluid pool in the gut, the abdomen becomes silent and tympanitic, vomiting is effortless and there is absolute constipation, all matching the edematous bowel seen here.
Ref: Dutta Obstetrics 8e; Bailey & Love 27e.