Furderer Thomas, Mantion Georges, Heyd Bruno
University Hospital Besançon, Besançon, France.
BMJ Case Rep. 2015 May 12;2015:bcr2013009468. doi: 10.1136/bcr-2013-009468.
Few data are available regarding emergency surgery for Crohn's disease (CD) during pregnancy. A 22-year -old woman, at 26 weeks of pregnancy, was admitted for premature labour, intestinal obstruction and systemic inflammation. Biology and ultrasonography were not helpful; imaging was completed with a CT scan, which confirmed the mechanical ileal obstruction. The intestinal obstruction worsened and led to emergency surgery. An inflammatory stenosis of the terminal ileum with two fistulas was found. An ileal resection and ileostomy were performed. The pathological analysis of the resected specimen confirmed CD. The postoperative course was uneventful. The delivery of a baby with normal weight and status occurred at term (40 weeks of amenorrhoea). There have been only 10 case reports of intestinal complications revealing CD during pregnancy. The delay in diagnosis and adequate treatment led to significant maternal and fetal morbidity and mortality. This case suggests that intestinal surgery for CD is feasible during pregnancy and may be associated with a favourable outcome for the baby as well as for the mother.
关于孕期克罗恩病(CD)急诊手术的可用数据很少。一名22岁女性,孕26周时因早产、肠梗阻和全身炎症入院。生物学检查和超声检查均无帮助;通过CT扫描完成影像学检查,证实为机械性回肠梗阻。肠梗阻加重并导致急诊手术。发现末端回肠炎性狭窄伴两个瘘管。进行了回肠切除和回肠造口术。切除标本的病理分析证实为CD。术后过程顺利。足月(停经40周)分娩出一名体重和状况正常的婴儿。仅有10例孕期肠道并发症提示CD的病例报告。诊断和充分治疗的延迟导致了严重的母婴发病和死亡。该病例表明,孕期CD肠道手术是可行的,对婴儿和母亲都可能带来良好结局。