Small Bowel Obstruction Secondary to Chronic Pelvic Fistula: A Case Report

Abstract

Small bowel obstructions caused by inflammatory adhesions without prior surgical history are rare and often linked to chronic infectious processes. Their association with pelvic fistulas, especially anal or vesical, complicates both diagnosis and management. We report the case of a 42-year-old male with no prior abdominal or pelvic surgery who developed an acute small bowel obstruction (SBO) caused by an inflammatory ileovesical adhesion associated with a chronic anal fistula. Two months earlier, the patient had been treated medically for an intervesico-rectal collection. Imaging revealed a closed-loop obstruction and a pre-rectal abscess. Surgical exploration confirmed a purulent intervesico-rectal collection and an obstructive inflammatory band. Cultures identified Escherichia coli. The patient had a favorable postoperative course and was referred for gastroenterological management of the chronic fistula. Inflammatory adhesions complicating chronic pelvic sepsis should be considered in SBO without prior surgery. A multidisciplinary approach is essential for diagnosis and treatment.