A Case of a Crohn's Disease–Complicated Pregnancy Saved by Emergency Cesarean Section and Colostomy for Pan–peritonitis

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The patient, a 40–year–old multiparous woman, was in the 29<SUP>th</SUP> week of gestation when she complained of left lower abdominal pain. Colonoscopy was performed in another institution, revealing discontinuous geographical redness and edematous swelling in the lower rectum, as well as narrowing of the lumen from the rectosigmoid to the sigmoid colon. Crohn's disease was diagnosed on the basis of the findings, the clinical course, and the fact that skin tags were also present. However, the following day, the inflammatory findings and abdominal pain worsened, and the patient was referred to our hospital, since NICU management for the baby was considered necessary. A CT scan did not show any clear abscess formation nor free air, but panperitonitis was diagnosed on the basis of the abdominal findings, and emergency surgery was thus performed. Caesarean section was performed first. Copious amounts of white moss–like adherent and contaminated ascites were observed centred on the sigmoid colon, and it was concluded that minor leakage had caused the peritonitis. We decided priority the life of the patient, palliative stoma was created at the splenic flexure of the transverse colon. Both the mother and the baby had good postoperative courses.
日本外科系連合学会の論文