Pathological post-obstructive diuresis following obstructive uropathy due to constipation in the post-partum period: a case report

Abstract Background Constipation during pregnancy is not uncommon. Usually, this does not warrant extensive evaluation and settles with minor interventions or lifestyle modifications. Severe fecal impaction in chronically constipated patients can rarely lead to obstructive uropathy. Relief of obstru...

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Autores principales:	Mohamed Rishard, Thalagala Kossinnage Maheeka Kossinna, Mohamed Nazar Latiff, Susantha De Silva, Mohamed Hilmy Mohamed Asmath
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Constipation Post-obstructive diuresis Obstructive uropathy Post-partum morbidity Fecal impaction Gynecology and obstetrics RG1-991
Acceso en línea:	https://doaj.org/article/3463e6469f9d4f778b54385a7f7b1595
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spelling	oai:doaj.org-article:3463e6469f9d4f778b54385a7f7b15952021-11-08T11:04:18ZPathological post-obstructive diuresis following obstructive uropathy due to constipation in the post-partum period: a case report10.1186/s12884-021-04218-11471-2393https://doaj.org/article/3463e6469f9d4f778b54385a7f7b15952021-11-01T00:00:00Zhttps://doi.org/10.1186/s12884-021-04218-1https://doaj.org/toc/1471-2393Abstract Background Constipation during pregnancy is not uncommon. Usually, this does not warrant extensive evaluation and settles with minor interventions or lifestyle modifications. Severe fecal impaction in chronically constipated patients can rarely lead to obstructive uropathy. Relief of obstruction can result in a diuretic phase which may be self-limiting or pathological. However, occurrence of pathological post-obstructive diuresis as a result of severe constipation is an extremely rare complication during pregnancy and puerperium which can even be fatal if not promptly diagnosed and adequately monitored and timely intervened. We describe the management of a pathological post-obstructive diuresis which occurred in the immediate postpartum period after treatment of severe constipation and obstructive uropathy. Case presentation A woman who had undergone an emergency caesarean section due to deep transverse arrest 1 week ago, presented with fecal impaction and anuria. On relief of urinary obstruction which had developed secondary to fecal impaction, she developed pathological post-obstructive diuresis. Careful and timely monitoring with exact fluid replacement, correction of electrolyte imbalances and multidisciplinary care ensured complete recovery of the patient. Conclusions Despite obstructive uropathy being uncommon in obstetric practice, clinicians need to have a high index of suspicion to monitor and promptly manage the potentially life-threatening condition of post-obstructive diuresis in pregnant and puerperal women undergoing urinary tract decompression. Due to unreliability of laboratory cutoff values in pregnancy and puerperium, a more vigilant and multidisciplinary approach with lower threshold for intervention is more prudent in the management of these patients.Mohamed RishardThalagala Kossinnage Maheeka KossinnaMohamed Nazar LatiffSusantha De SilvaMohamed Hilmy Mohamed AsmathBMCarticleConstipationPost-obstructive diuresisObstructive uropathyPost-partum morbidityFecal impactionGynecology and obstetricsRG1-991ENBMC Pregnancy and Childbirth, Vol 21, Iss 1, Pp 1-5 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Constipation Post-obstructive diuresis Obstructive uropathy Post-partum morbidity Fecal impaction Gynecology and obstetrics RG1-991
spellingShingle	Constipation Post-obstructive diuresis Obstructive uropathy Post-partum morbidity Fecal impaction Gynecology and obstetrics RG1-991 Mohamed Rishard Thalagala Kossinnage Maheeka Kossinna Mohamed Nazar Latiff Susantha De Silva Mohamed Hilmy Mohamed Asmath Pathological post-obstructive diuresis following obstructive uropathy due to constipation in the post-partum period: a case report
description	Abstract Background Constipation during pregnancy is not uncommon. Usually, this does not warrant extensive evaluation and settles with minor interventions or lifestyle modifications. Severe fecal impaction in chronically constipated patients can rarely lead to obstructive uropathy. Relief of obstruction can result in a diuretic phase which may be self-limiting or pathological. However, occurrence of pathological post-obstructive diuresis as a result of severe constipation is an extremely rare complication during pregnancy and puerperium which can even be fatal if not promptly diagnosed and adequately monitored and timely intervened. We describe the management of a pathological post-obstructive diuresis which occurred in the immediate postpartum period after treatment of severe constipation and obstructive uropathy. Case presentation A woman who had undergone an emergency caesarean section due to deep transverse arrest 1 week ago, presented with fecal impaction and anuria. On relief of urinary obstruction which had developed secondary to fecal impaction, she developed pathological post-obstructive diuresis. Careful and timely monitoring with exact fluid replacement, correction of electrolyte imbalances and multidisciplinary care ensured complete recovery of the patient. Conclusions Despite obstructive uropathy being uncommon in obstetric practice, clinicians need to have a high index of suspicion to monitor and promptly manage the potentially life-threatening condition of post-obstructive diuresis in pregnant and puerperal women undergoing urinary tract decompression. Due to unreliability of laboratory cutoff values in pregnancy and puerperium, a more vigilant and multidisciplinary approach with lower threshold for intervention is more prudent in the management of these patients.
format	article
author	Mohamed Rishard Thalagala Kossinnage Maheeka Kossinna Mohamed Nazar Latiff Susantha De Silva Mohamed Hilmy Mohamed Asmath
author_facet	Mohamed Rishard Thalagala Kossinnage Maheeka Kossinna Mohamed Nazar Latiff Susantha De Silva Mohamed Hilmy Mohamed Asmath
author_sort	Mohamed Rishard
title	Pathological post-obstructive diuresis following obstructive uropathy due to constipation in the post-partum period: a case report
title_short	Pathological post-obstructive diuresis following obstructive uropathy due to constipation in the post-partum period: a case report
title_full	Pathological post-obstructive diuresis following obstructive uropathy due to constipation in the post-partum period: a case report
title_fullStr	Pathological post-obstructive diuresis following obstructive uropathy due to constipation in the post-partum period: a case report
title_full_unstemmed	Pathological post-obstructive diuresis following obstructive uropathy due to constipation in the post-partum period: a case report
title_sort	pathological post-obstructive diuresis following obstructive uropathy due to constipation in the post-partum period: a case report
publisher	BMC
publishDate	2021
url	https://doaj.org/article/3463e6469f9d4f778b54385a7f7b1595
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Pathological post-obstructive diuresis following obstructive uropathy due to constipation in the post-partum period: a case report

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