Fever and right upper quadrant pain in a pregnant woman at 30 weeks' gestation.
BACKGROUND
A 34-year-old gravid woman with a history of ileal Crohn's disease presented at 30 weeks' gestation with a 2-week history of fever and right upper quadrant pain. An intra-abdominal abscess was suspected. Ultrasound and MRI failed to demonstrate the suspected abscess. Owing to ongoing pain and fever, the risk to the fetus of a CT scan were discussed with the patient, obstetricians and radiologists, with considerable debate about the possibility of other explanations for her symptoms. Ultimately, a CT scan revealed marked thickening of the distal ileum and confirmed diagnosis of an abscess in continuity with the inflamed bowel.


METHODS
Ultrasound, MRI, CT scan, urinalysis, urine culture and liver function tests.


METHODS
Crohn's disease flare complicated by an intra-abdominal abscess.


RESULTS
Antibiotics (ceftizoxime, metronidazole and amoxicillin/clavulanate potassium), parenteral nutrition and ileocecectomy.
Harrell
Laura E
LE
Section of Gastroenterology and Nutrition, University of Chicago, IL, USA.
Rubin
David T
DT
Hanauer
Stephen B
SB
D018784:Abdominal Abscess / Q000175:diagnosis* / Q000209:etiology* / Q000628:therapy; D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003424:Crohn Disease / Q000150:complications*; D003937:Diagnosis, Differential; D013505:Digestive System Surgical Procedures / Q000379:methods; D004322:Drainage / Q000379:methods; D005260:Female; D005334:Fever / Q000209:etiology; D006801:Humans; D007077:Ileal Diseases / Q000150:complications*; D011247:Pregnancy; D011263:Pregnancy Trimester, Third; D014057:Tomography, X-Ray Computed
D000900:Anti-Bacterial Agents