Fulminant ulcerative colitis in a healthy pregnant woman

• Published in: World journal of gastroenterology : WJG Vol. 21; no. 19; pp. 6060 - 6064
• Main Authors: Orabona, Rossana, Valcamonico, Adriana, Salemme, Marianna, Manenti, Stefania, Tiberio, Guido A M, Frusca, Tiziana
• Format: Journal Article
• Language: English
• Published: United States Baishideng Publishing Group Inc 21-05-2015
• Subjects: Adult; Biopsy; Case Report; Cesarean Section; colitis; Colitis, Ulcerative - complications; Colitis, Ulcerative - diagnosis; Colitis, Ulcerative - therapy; Colonoscopy; Decompression, Surgical - methods; Female; Gestational Age; Humans; Immunosuppressive Agents - therapeutic use; megacolon; Megacolon, Toxic - diagnosis; Megacolon, Toxic - etiology; Megacolon, Toxic - therapy; Pregnancy; Pregnancy Complications, Infectious - diagnosis; Pregnancy Complications, Infectious - etiology; Pregnancy Complications, Infectious - therapy; Pregnancy Trimester, Third; Pregnancy;Cesarean; Premature Birth; section; Sepsis - diagnosis; Sepsis - etiology; Severity of Illness Index; Tomography, X-Ray Computed; Toxic; Treatment Outcome; Ulcerative; Pregnancy; Toxic megacolon; Colonoscopy; Cesarean section; Ulcerative colitis
• ISSN: 1007-9327; 2219-2840
• DOI: 10.3748/wjg.v21.i19.6060

This case report concerns a 25-year-old patient with6-7 bloody stools/d, abdominal pain, tachycardia,and weight loss occurring during the third trimesterof pregnancy. Severe ulcerative colitis complicated bytoxic megacolon and gravidic sepsis was diagnosedby clinical evaluation, colonoscopy, and rectal biopsythat were performed safely without risk for the motheror baby. The patient underwent a cesarean section at28＋6 wk gestation. The baby was transferred to theneonatal intensive care unit of our hospital and survivedwithout complications. Fulminant colitis was managedconservatively by combined colonoscopic decompressionand medical treatment. Although current Europeanguidelines describe toxic megacolon as an indication foremergency surgery for both pregnant and non-pregnantwomen, thanks to careful monitoring, endoscopicdecompression, and intensive medical therapy withnutritional support, we prevented the woman fromhaving to undergo emergency pancolectomy. Our reportseems to suggest that conservative management maybe a helpful tool in preventing pancolectomy if thepatient＇s condition improves quickly. Otherwise, surgeryis mandatory.