title: Therapy of complicated Crohn's disease during pregnancy--an interdisciplinary challenge.
abstract: BACKGROUND
  Severe courses of Crohn's disease (CD) during pregnancy are rare. However, if occurring, the risk of miscarriage and low birth weight is increased. At present, only limited data is available on the treatment of CD during pregnancy. In particular, there are no standard guidelines for surgical therapy. Nevertheless, surgery is often unavoidable if complications during the course of the disease arise.
  
  
  OBJECTIVE
  This study provides a critical overview of conventional and interventional treatment options for CD complications during pregnancy and analyses the surgical experience gained thus far. For illustrative purposes, clinical cases of three young women with a severe clinical course during pregnancy are presented.
  
  
  METHODS
  After treatment-refractory for conservative and interventional measures, surgery remained as the only treatment option. In all cases, a split stoma was created after resection to avoid anastomotic leaks that would endanger the lives of mother and child. The postoperative course of all three patients was uneventful, and pregnancy remained intact until delivery. No further CD specific medication was required before birth.
  
  
  CONCLUSIONS
  The management of CD patients during pregnancy requires close interdisciplinary co-operation between gastroenterologists, obstetricians, anaesthetists and visceral surgeons. For the protection of mother and child treatment should thus be delivered in a specialised centre. This article demonstrates the advantages of surgical therapy by focusing on alleviating CD complaints and preventing postoperative complications.
authors.affiliation: Department of General, Visceral and Vascular Surgery, Charité - Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany, claudia.seifarth@charite.de.
authors.forename: C
authors.initials: C
authors.lastname: Seifarth
authors.forename: J P
authors.initials: JP
authors.lastname: Ritz
authors.forename: U
authors.initials: U
authors.lastname: Pohlen
authors.forename: A J
authors.initials: AJ
authors.lastname: Kroesen
authors.forename: B
authors.initials: B
authors.lastname: Siegmund
authors.forename: B
authors.initials: B
authors.lastname: Frericks
authors.forename: H J
authors.initials: HJ
authors.lastname: Buhr
mesh_terms: D018784:Abdominal Abscess / Q000601:surgery; D000038:Abscess / Q000601:surgery; D000328:Adult; D000758:Anesthesia / Q000009:adverse effects; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D003424:Crohn Disease / Q000150:complications / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007077:Ileal Diseases / Q000601:surgery; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007412:Intestinal Fistula / Q000601:surgery; D010348:Patient Care Team; D011247:Pregnancy; D011248:Pregnancy Complications / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*; D012074:Remission Induction; D012307:Risk Factors; D054047:Surgical Stomas; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D000900:Anti-Bacterial Agents; D005938:Glucocorticoids; D007166:Immunosuppressive Agents; D014409:Tumor Necrosis Factor-alpha