Interwoven Causes of Post Operative Ileus in The Context of Preeclampsia with Severe Features: A Case Report

Abstract

Hypermagnesemia is a rare cause of post operative ileus. Hyponatremia, Hypochloremia, and severe Hypoalbuminemia alone will not cause ileus, but when combine, may prolong the duration of the ileus of another etiology. We present the case of a 49 years old G1P0, dichorionic diamniotic twin pregnancy at 35 weeks’ gestation following IVF, complicated by preeclampsia with severe features; severely elevated blood pressure, epigastric pains and CNS prodromal symptoms (severe headache and blurred vision). She underwent an emergency Cesarean section indicated for a persistently elevated severe range blood pressure measurements, despite receiving more than two antihypertensives, in the context of CNS prodromal symptoms of severe headache and blurred vision. She received a loading dose of 14g Magnesium sulphate prior to surgery. Her 2nd to 6th postoperative days were marked by an adynamic intestinal obstruction from hypermagnesemia, prolonged by severe hypoproteinemia, hyponatremia and hypochloremia. The was an associated haemorrhage at the surgical site, due to increased intra-abdominal pressure from the obstruction coupled with the severely elevated blood pressure. This case report reiterates the importance of evaluating the maternal serum magnesium prior to the administration of magnesium sulphate and secondly the role of very low maternal serum albumin levels in prolonging post operative ileus, especially in the context of Preeclampsia in Obstetrics.