Abdominal Catastrophes in the Obstetric Patient; Perforated Crohn’s Disease
Severe exacerbations of Crohn’s Disease (CD) requiring acute surgery are rare, and even rarer still are those that occur during pregnancy. The typical age of onset for CD is 15-30 years old, therefore affecting women during their child-bearing years. One review, noted a majority of pregnant patient with IBD were diagnosed prior to pregnancy, however, 4.1% of women with CD were diagnosed during pregnancy. No data suggests that CD is more severe during pregnancy, however, when operative intervention is required; there are unique surgical and anesthesiological considerations.
A 24 year old female at 27 weeks gestation presented to our institution with abdominal pain and concern for preterm labor. The patient had undergone a laparoscopic cholecystectomy for chronic cholecystitis ten days prior at another institution, which is where she presented for a prenatal visit. In the transfer record, patient had multiple recent admissions due to emesis, attributed to hyperemesis gravidum and cholecystitis. On admission to our institution, she complained of uncomfortable cramping abdominal pain with concern for preterm labor. She was febrile, with a leukocytosis of 26.3. The obstetric service performed a negative amniocentesis for what they suspected to be chorioamnionitis. Ten hours after admission, her pain failed to improve, she was placed on piperacillin/tazobactam. MRI was obtained and demonstrated a