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Can I carry pregnancy after COLON RESECTION for ADHESIONS?

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I am 36 years old patientold and have had 2 c sections, the last in 2008. I had an emergency laparotomy for a colon resection in 2011. it was due to adhesions from the c sections. Recovery was uneventful and I live a normal life minus 2 feet of intestines. Now I am accidently pregnant and need to know if you think I can even carry the pregnancy. please help.

Category: OBGYN

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Category: Infertility Specialist
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Hello
Thanks for posting your query at DoctorSpring.com
You can have a pregnancy and carry it to term after a colon resection.
What I am worried about is the adhesions from previous surgeries.
They were already bad enough to require a colon resection.
The third C section might be horribly difficult to carry out, and you might risk injuring your bowel / bladder and other structures nearby.
A frank opinion - since you already have two kids, I would not consider this risk worth taking.
It is far less risky to have a termination ( and let me warn you, even that might be very difficult with your history ) than to have a full term pregnancy and another C section.
All the best
Please feel free to discuss further.


Patient replied :

I completely appreciate your frank opinion. I would like if you could explain why the adhesions are still a problem. Also, how much more of a chance do I stand to end up with another resection?? (OUCH). Its just that my husband and I almost split up and we cant help feel this baby is here for a reason. I went thru fertility treatments with the second one at 29 and bam here I am at 36..... but I am a reasonable person and abortion is an option, I am not against it if it is my best interest. Also, how would this make a termination risky? THANKS AGAIN


Hello
Thank you for the update on your situation.
Let me try and elaborate more on this aspect.
People respond differently to surgery.
Adhesions are a complication of a major abdominal surgery.
Some women might have no adhesions after multiple C sections, and some women have bad adhesions after even a small keyhole surgery.
In your case, you have a tendency to develop adhesions, and you had bad ones after your first two sections, requiring a colon resection which is a truly radical procedure.
Now, with one more Csection ( and you will definitely have a C section if this pregnancy goes to term ), you are at an extremely high risk of further adhesions.
In fact, the next C section itself might be very difficult due to remnant adhesions from the previous 2 times.
Nobody can say what are your chances, because as I said, everybody reacts differently, but since you are a high risk candidate for morbid adhesions, it is highly probable that you would have adhesions after your purported next C section.
These might involve the colon / intestine as earlier, or maybe the bladder, ureter or surrounding areas.
So as you can see, the next C section might be ghastly enough, and then , some time after that 3rd section, you might have dreaded complications as the adhesions would flare up, if not already bad enough :(
This is not some scary story for you, but a highly probable situation, given your inherent tendency for adhesions .
Now, your question regarding termination.
Normally, a pregnancy termination is first attempted via medications ( medical abortion ).
In women with prior C sections, this method maybe unsuccessful ( chances of failure of pills are 4 % in normal women, but with a prior surgery, chances of failure maybe much higher ).
Also, with 2 prior surgeries,and adhesions plus a colon resection ( which itself counts as a third surgery ) - pills are likely to fail.
Then you might need a surgical abortion, and that would be risky in view of the adhesions itself.
So as I said, compared to a nulliparous woman, even a termination is quite risky for you, but far less risky than another section at full term.
The more advanced the pregnancy, the more risky the termination becomes.
I hope I have managed to be more clear.
Let me know what you wish to know further.
Take care.


Dr. Aarti Vazirani
Category: Infertility Specialist
Experience: 
Residency: Obstetrics & Gynecolog, BJMC,Civil hospital, Ahmedabad, 2008
Post Graduate: MS (Obstetrics & Gynecology), B.J. Medical College, Ahmedabad, 2008
Medical School: MBBS, B.J. Medical College, Ahmedabad, 2004
Dr. Aarti Vazirani and 4 other Medical Specialists are ready to help you

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