EP.FRI.159 Crohn's terminal ileal perforation peri partum; a case report and review of the literature. (28th October 2021)

• Record Type: Journal Article
• Authors: Tokidis, Evripidis; Malcolm, Francesca; White, Timothy
• Is Part Of: British journal of surgery. Volume 108:Supplement 7(2021)
• Publication Date: 2021-10-28
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1093/bjs/znab312.032
• Languages: English
• ISSNs: 0007-1323

Abstract

Abstract: Introduction: Surgical care of complicated Crohn's disease (CD) during pregnancy is often a clinicodiagnostic conundrum. We present a case of a 26 year old with active CD and subsequent terminal ileal (TI) perforation diagnosed post-partum. Case: A 26 year old with known CD presented with abdominal pain at 24 weeks pregnant to Obstetrics. Surgical opinion was sought due to increasing abdominal pain; MRI was performed and found active TI CD but no free gas. Within 24 hours the patient prematurely delivered. Immediately post-partum the patient reported worsening pain with notable peritonism on examination. Urgent CT abdomen was arranged demonstrating free aim secondary to TI perforation. The patient underwent laparotomy. Intraoperatively there was 4 quadrant peritonitis, confined TI loops behind the gravid uterus and TI perforations. Following drainage of the intrabdominal sepsis, a ileo-caecal resection was performed with end ileostomy and colonic mucous fistula formation. Post-operative recovery was uneventful and the patient was discharged 5 days later. Discussion: There is a paucity of evidence describing manifestations of CD during pregnancy. Meta-analysis has shown a correlation of active CD and adverse perinatal outcome. The specific complication of TI perforation is a rare sequelae of CD; documented in less than 5% of cases. TI perforation during pregnancy has been described in only a handful of case reports. Conclusion: This case report illustrates diagnostic challenges faced in the investigation and management of active CD in pregnant patients. It also highlights the importance of dynamic reassessment and the collaborative efforts of the multidisciplinary team.