A Free Terminal Ileal Perforation From Active Crohn Disease in Pregnancy: A Diagnostic Challenge

Philip, Sunu; Kamyab, Armin; Orfanou, Paraskevi

doi:10.9738/intsurg-d-14-00070.1

Cited by 6 publications

(6 citation statements)

References 10 publications

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“…An additional three articles were identified from bibliographies and related citations that were deemed suitable for inclusion. Twenty‐four articles involved surgery for medically refractory or complicated UC and eight detailed the use of surgery in pregnant women with CD .…”

Section: Resultsmentioning

confidence: 99%

“…Several authors recommend laparoscopy as the operative approach of choice in the first and second trimesters, citing its diagnostic and therapeutic role, smaller incisions, less adhesion formation and quicker recovery . Support for laparoscopy in pregnant patients with IBD has generally been extrapolated from general surgical procedures during pregnancy or from the literature on IBD involving nonpregnant patients, and only two of the four reported cases in which this approach was used were completed laparoscopically .…”

Section: Discussionmentioning

confidence: 99%

“…The median age of the patients at time of surgery was 24.5 (21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37) years. Almost half presented in the second trimester and half of all cases were newly diagnosed during pregnancy [44][45][46][47][48][49][50][51]. Three patients who had been on medical therapy stopped their treatment on becoming pregnant, despite guidelines recommending otherwise.…”

Section: Surgery For CDmentioning

confidence: 99%

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Surgical management of complicated and medically refractory inflammatory bowel disease during pregnancy

2017

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Surgery For CDmentioning

confidence: 99%

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Surgical management of complicated and medically refractory inflammatory bowel disease during pregnancy

2017

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“…Other causes include Crohn disease, irradiation, obstruction, nonspecific inflammation, embolic events, and tuberculosis. 7,10,11 Verocytotoxin-producing E. coli and PWS have not been reported to cause perforation at the terminal ileum. The decreased intestinal motility from PWS may have resulted in increased VTEC toxin exposure for a relatively prolonged period at the terminal ileum.…”

Section: Discussionmentioning

confidence: 99%

Terminal Ileum Perforation

Duffy

Kesha²,

Glenn³

et al. 2021

Am J Forensic Med Pathol

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Intestinal perforation is an uncommon complication and presentation of verocytotoxigenic Escherichia coli (VTEC) infection in individuals with Prader-Willi syndrome (PWS). The common site of perforation from VTEC infection is in the colon (and almost exclusively in the pediatric population), whereas PWS is in the stomach. Terminal ileum perforation is uncommon and is not reported in either these 2 conditions. We report a death from terminal ileum perforations in an adult who had PWS and was infected with VTEC. Potential reasons why the perforation occurred at this rare location, rather than in other more common location, in an adult are discussed.

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“…In CD, perforations in the small bowel commonly occur at the terminal ileum due to penetrating disease (67,68). Patients complain of pain in the right iliac fossa and experience tenderness, usually associated with fever.…”

Section: Penetrating Small Bowel CDmentioning

confidence: 99%

Surgical Management of Small Bowel Crohn's Disease

Chandrasinghe

2022

Front. Surg.

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Crohn's disease in the small bowel could present itself as an inflammatory stricture, a fibrotic stricture as penetrating disease or a combination of both. It is pertinent to differentiate the disease process as well as its extent to effectively manage the disease. Currently, a combination of medical and surgical therapies forms part of the treatment plan while the debate of which therapy is better continues. In managing the strictures, identification of the disease process through imaging plays a pivotal role as inflammatory strictures respond to anti-tumor necrosis factor (TNF) and biological agents, while fibrotic strictures require endoscopic or surgical intervention. Recent evidence suggests a larger role for surgical excision, particularly in ileocolic disease, while achieving a balance between disease clearance and bowel preservation. Several adaptations to the surgical technique, such as wide mesenteric excision, side to side or Kono-S anastomosis, and long-term metronidazole therapy, are being undertaken even though their absolute benefit is yet to be determined. Penetrating disease requires a broader multidisciplinary approach with a particular focus on nutrition, skincare, and intestinal failure management. The current guidance directs toward early surgical intervention for penetrating disease when feasible. Accurate preoperative imaging, medical management of active diseases, and surgical decision-making based on experience and evidence play a key role in success.

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A Free Terminal Ileal Perforation From Active Crohn Disease in Pregnancy: A Diagnostic Challenge

Cited by 6 publications

References 10 publications

Surgical management of complicated and medically refractory inflammatory bowel disease during pregnancy

Surgical management of complicated and medically refractory inflammatory bowel disease during pregnancy

Terminal Ileum Perforation

Surgical Management of Small Bowel Crohn's Disease

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