Salvage therapy for acute severe ulcerative colitis during pregnancy

Ulcerative colitis (UC) is a chronic inflammatory bowel disease with an age of onset that affects young people during the peak of their reproductive years. Management of flares of disease during pregnancy can be complex and there are few case reports of pregnant women with acute severe ulcerative co...

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Bibliographic Details
Published in:BMJ case reports 2018-06, Vol.2018, p.bcr-2017-223540
Main Authors: Raval, Manjri, Choy, Matthew C, De Cruz, Peter
Format: Article
Language:English
Subjects:
Abdomen
Adult
Case reports
Cesarean Section - methods
Colectomy - methods
Colitis, Ulcerative - complications
Colitis, Ulcerative - drug therapy
Colitis, Ulcerative - surgery
Colon
Cyclosporine - administration & dosage
Cyclosporine - therapeutic use
Cytomegalovirus
Diagnosis, Differential
Female
Gastrointestinal Agents - therapeutic use
Heart rate
HELLP Syndrome - etiology
Histology
Humans
Hydrocortisone - administration & dosage
Hydrocortisone - therapeutic use
Immunosuppressive Agents - therapeutic use
Inflammatory bowel disease
Infliximab - administration & dosage
Infliximab - therapeutic use
Laparoscopy - methods
Monoclonal antibodies
Patients
Pregnancy
Salvage Therapy - methods
Severity of Illness Index
Surgery
Systematic review
TNF inhibitors
Treatment Outcome
Tumor necrosis factor-TNF
Unusual Presentation of More Common Disease/Injury
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Summary:Ulcerative colitis (UC) is a chronic inflammatory bowel disease with an age of onset that affects young people during the peak of their reproductive years. Management of flares of disease during pregnancy can be complex and there are few case reports of pregnant women with acute severe ulcerative colitis (ASUC). We present the case of a 31-year-old pregnant woman who at 16 weeks gestation developed ASUC in the context of primary non-response to infliximab therapy. She subsequently underwent an emergency laparoscopic colectomy after failing to respond to hydrocortisone and cyclosporine salvage therapy. Her pregnancy was further complicated by HELLP (Haemolysis, Elevated liver enzymes and Low Platelets) syndrome resulting in premature delivery at 27 weeks gestation. This case highlights the management issues involved in ASUC during pregnancy and the assessment of disease activity, use of salvage therapies, and provides a framework to approach this complex medical emergency.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2017-223540