Fulminant ulcerative colitis in a healthy pregnant woman.

Szczegóły
Abstrakt

Tytuł:: Fulminant ulcerative colitis in a healthy pregnant woman.
Autorzy:: Orabona R; Rossana Orabona, Adriana Valcamonico, Tiziana Frusca, Maternal Fetal Medicine Unit, Department of Obstetrics and Gynecology, University of Brescia, 25123 Brescia, Italy.
Valcamonico A; Rossana Orabona, Adriana Valcamonico, Tiziana Frusca, Maternal Fetal Medicine Unit, Department of Obstetrics and Gynecology, University of Brescia, 25123 Brescia, Italy.
Salemme M; Rossana Orabona, Adriana Valcamonico, Tiziana Frusca, Maternal Fetal Medicine Unit, Department of Obstetrics and Gynecology, University of Brescia, 25123 Brescia, Italy.
Manenti S; Rossana Orabona, Adriana Valcamonico, Tiziana Frusca, Maternal Fetal Medicine Unit, Department of Obstetrics and Gynecology, University of Brescia, 25123 Brescia, Italy.
Tiberio GA; Rossana Orabona, Adriana Valcamonico, Tiziana Frusca, Maternal Fetal Medicine Unit, Department of Obstetrics and Gynecology, University of Brescia, 25123 Brescia, Italy.
Frusca T; Rossana Orabona, Adriana Valcamonico, Tiziana Frusca, Maternal Fetal Medicine Unit, Department of Obstetrics and Gynecology, University of Brescia, 25123 Brescia, Italy.
Źródło:: World journal of gastroenterology [World J Gastroenterol] 2015 May 21; Vol. 21 (19), pp. 6060-4.
Typ publikacji:: Case Reports; Journal Article
Język:: English
Imprint Name(s):: Publication: 2014- : Pleasanton, CA : Baishideng Publishing Group
Original Publication: Beijing : WJG Press, c1998-
MeSH Terms:: Colitis, Ulcerative/*complications
Megacolon, Toxic/*etiology
Pregnancy Complications, Infectious/*etiology
Sepsis/*etiology
Adult ; Biopsy ; Cesarean Section ; Colitis, Ulcerative/diagnosis ; Colitis, Ulcerative/therapy ; Colonoscopy ; Decompression, Surgical/methods ; Female ; Gestational Age ; Humans ; Immunosuppressive Agents/therapeutic use ; Megacolon, Toxic/diagnosis ; Megacolon, Toxic/therapy ; Pregnancy ; Pregnancy Complications, Infectious/diagnosis ; Pregnancy Complications, Infectious/therapy ; Pregnancy Trimester, Third ; Premature Birth ; Sepsis/diagnosis ; Severity of Illness Index ; Tomography, X-Ray Computed ; Treatment Outcome
References:: Am J Gastroenterol. 2003 Nov;98(11):2363-71. (PMID: 14638335)
J Crohns Colitis. 2015 Jan;9(1):4-25. (PMID: 25304060)
J Matern Fetal Neonatal Med. 2004 Apr;15(4):237-41. (PMID: 15280131)
Scand J Gastroenterol. 1983 Sep;18(6):735-42. (PMID: 6669937)
J Clin Gastroenterol. 1984 Jun;6(3):211-6. (PMID: 6144706)
J Reprod Med. 1987 Nov;32(11):869-72. (PMID: 3430496)
Dig Dis Sci. 1996 Dec;41(12):2353-61. (PMID: 9011442)
Gastroenterol Clin North Am. 1998 Mar;27(1):213-24. (PMID: 9546091)
Compr Ther. 1998 Sep;24(9):409-14. (PMID: 9784946)
Br Med J. 1955 Oct 29;2(4947):1041-8. (PMID: 13260656)
Singapore Med J. 2006 Jun;47(6):525-8. (PMID: 16752022)
J Gastroenterol Hepatol. 2007 Apr;22(4):542-9. (PMID: 17376049)
Gastroenterology. 2007 Oct;133(4):1106-12. (PMID: 17764676)
Am J Gastroenterol. 2008 May;103(5):1203-9. (PMID: 18422816)
Inflamm Bowel Dis. 2010 May;16(5):847-55. (PMID: 19795509)
J Crohns Colitis. 2010 Nov;4(5):493-510. (PMID: 21122553)
Nat Rev Gastroenterol Hepatol. 2011 Nov;8(11):610-34. (PMID: 21970872)
J Crohns Colitis. 2012 Dec;6(10):991-1030. (PMID: 23040451)
Aliment Pharmacol Ther. 2004 Jan 15;19(2):179-89. (PMID: 14723609)
Contributed Indexing:: Keywords: Cesarean section; Colonoscopy; Pregnancy; Toxic megacolon; Ulcerative colitis
Substance Nomenclature:: 0 (Immunosuppressive Agents)
Entry Date(s):: Date Created: 20150529 Date Completed: 20160202 Latest Revision: 20181113
Update Code:: 20240104
PubMed Central ID:: PMC4438043
DOI:: 10.3748/wjg.v21.i19.6060
PMID:: 26019473
: Czasopismo naukowe

This case report concerns a 25-year-old patient with 6-7 bloody stools/d, abdominal pain, tachycardia, and weight loss occurring during the third trimester of pregnancy. Severe ulcerative colitis complicated by toxic megacolon and gravidic sepsis was diagnosed by clinical evaluation, colonoscopy, and rectal biopsy that were performed safely without risk for the mother or baby. The patient underwent a cesarean section at 28+6 wk gestation. The baby was transferred to the neonatal intensive care unit of our hospital and survived without complications. Fulminant colitis was managed conservatively by combined colonoscopic decompression and medical treatment. Although current European guidelines describe toxic megacolon as an indication for emergency surgery for both pregnant and non-pregnant women, thanks to careful monitoring, endoscopic decompression, and intensive medical therapy with nutritional support, we prevented the woman from having to undergo emergency pancolectomy. Our report seems to suggest that conservative management may be a helpful tool in preventing pancolectomy if the patient's condition improves quickly. Otherwise, surgery is mandatory.

Informacja