Orabona R, Valcamonico A, Salemme M, Manenti S, Tiberio GA, Frusca T. Fulminant ulcerative colitis in a healthy pregnant woman. World J Gastroenterol 2015; 21(19): 6060-6064 [PMID: 26019473 DOI: 10.3748/wjg.v21.i19.6060]
Corresponding Author of This Article
Rossana Orabona, MD, Maternal Fetal Medicine Unit, Department of Obstetrics and Gynecology, University of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy. oraroxy@libero.it
Research Domain of This Article
Gastroenterology & Hepatology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Rossana Orabona, Adriana Valcamonico, Tiziana Frusca, Maternal Fetal Medicine Unit, Department of Obstetrics and Gynecology, University of Brescia, 25123 Brescia, Italy
Marianna Salemme, Stefania Manenti, Pathology Department, University of Brescia, 25123 Brescia, Italy
Guido AM Tiberio, Surgical Clinic, Department of Clinical and Experimental Sciences, University of Brescia, 25123 Brescia, Italy
Author contributions: Orabona R designed the report; Orabona R, Salemme M and Manenti S collected the patient’s clinical data; Orabona R, Valcamonico A, Tiberio GAM and Frusca T analyzed the data and wrote the paper.
Ethics approval: According to Italian regulations, ethical committee approval is not required for case reports analyzing anonymized routinely-collected data.
Informed consent: The patient gave her informed verbal consent prior to study inclusion.
Conflict-of-interest: Each author has nothing to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Rossana Orabona, MD, Maternal Fetal Medicine Unit, Department of Obstetrics and Gynecology, University of Brescia, Piazzale Spedali Civili 1, 25123 Brescia, Italy. oraroxy@libero.it
Telephone: +39-303-995340 Fax: +39-303-995340
Received: November 25, 2014 Peer-review started: December 1, 2014 First decision: January 8, 2015 Revised: January 24, 2015 Accepted: February 13, 2015 Article in press: February 13, 2015 Published online: May 21, 2015 Processing time: 176 Days and 14.5 Hours
Abstract
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.
Core tip: Severe ulcerative colitis complicated by toxic megacolon is widely considered to be an indication for emergency surgery. We reported a case of acute colitis in a healthy pregnant woman conservatively treated by intensive monitoring combined with medical therapy and endoscopic decompression in order to prevent the mother from having to undergo pancolectomy and the neonate from suffering an adverse perinatal outcome.
