Ischaemic bowel perforation secondary to a gravid uterus in a patient with treated inflammatory bowel disease and an ileoanal pouch: a case report

Abstract

The diagnosis of visceral perforation during pregnancy is often delayed and the management complex. A 32-year-old primigravid woman in her second trimester presented with abdominal pain and a pre-existing ileoanal pouch. Initial imaging was negative but later imaging was suggestive of serious pathology. At laparotomy, a caesarean section was performed. Peritonitis was encountered secondary to two discrete perforations in the small bowel separate from her pouch. Histology found an ischaemic perforation secondary to a pressure effect from the gravid uterus. In pregnancy, ileoanal pouches may make the interconnected bowel vulnerable to the pressure effect of the gravid uterus and perforation. Pregnant women with such a surgical history who develop symptoms suggestive of bowel perforation should have rapid imaging and their clinical team should consider early definitive surgical intervention.

Two-time perforation of the ileal J-pouch 6 and 18 years after restorative proctocolectomy and ileal pouch–anal anastomosis for familial adenomatous polyposis: a case report

“…Hsu and Leonid et al reported perforation of the ileal pouch due to external factors, such as blunt trauma [ 11 , 12 ]. In pregnant women with an enlarged uterus, increased pouch pressure associated with perforation in relation to adhesions were reported [ 13 , 14 ]. Other perforations are caused by Salmonella typhimurium infection [ 15 ], volvulus and subsequent obstruction of the terminal ileum [ 16 ], and idiopathic spontaneous perforation of the pouch [ 17 ].…”