title: Surgery for Severe Ulcerative Colitis during Pregnancy: Report of Two Cases.
abstract: Refractory ulcerative colitis (UC) that does not respond to medical therapy often requires surgery even during pregnancy. Although surgical cases of UC during pregnancy were reported previously, the standard surgical strategy for both colitis and pregnancy was unclear. Herein, fetal and maternal safety as well as the strategy for this unusual surgical procedure during pregnancy in patients with UC are considered. A 28-year-old woman was diagnosed with left-sided moderate UC at 12 weeks of pregnancy; toxic megacolon was suspected, and surgery was required. Although the baby's gestational age was 23 weeks and 3 days, a cesarean section was performed before the colectomy. In a next case, a 28-year-old woman had a 2-year history of left-sided UC. Her colitis flared up at 11 weeks of pregnancy. Colectomy was performed because her colitis was unresponsive to conservative therapy, and the pregnancy was continued, with a transvaginal delivery at 36 weeks. In patients with UC, the need for surgery should be determined promptly based on disease severity, whether or not the patient is pregnant. The need for surgery should not be affected by pregnancy. The pregnancy should be continued for as long as possible when there are no fetal and maternal complications. Both cesarean section and colectomy should be performed independently if necessary.
authors.affiliation: Department of Inflammatory Bowel Disease, Hyogo College of Medicine, Nishinomiya, Kakogawa, Japan.
authors.forename: Motoi
authors.initials: M
authors.lastname: Uchino
authors.affiliation: Department of Inflammatory Bowel Disease, Hyogo College of Medicine, Nishinomiya, Kakogawa, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Ikeuchi
authors.affiliation: Department of Inflammatory Bowel Disease, Hyogo College of Medicine, Nishinomiya, Kakogawa, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Matsuoka
authors.affiliation: Department of Inflammatory Bowel Disease, Hyogo College of Medicine, Nishinomiya, Kakogawa, Japan.
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Bando
authors.affiliation: Department of Inflammatory Bowel Disease, Hyogo College of Medicine, Nishinomiya, Kakogawa, Japan.
authors.forename: Kei
authors.initials: K
authors.lastname: Hirose
authors.affiliation: Department of Inflammatory Bowel Disease, Hyogo College of Medicine, Nishinomiya, Kakogawa, Japan.
authors.forename: Akihiro
authors.initials: A
authors.lastname: Hirata
authors.affiliation: Department of Inflammatory Bowel Disease, Hyogo College of Medicine, Nishinomiya, Kakogawa, Japan.
authors.forename: Teruhiro
authors.initials: T
authors.lastname: Chohno
authors.affiliation: Department of Inflammatory Bowel Disease, Hyogo College of Medicine, Nishinomiya, Kakogawa, Japan.
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Sasaki
authors.affiliation: Department of Inflammatory Bowel Disease, Hyogo College of Medicine, Nishinomiya, Kakogawa, Japan.
authors.forename: Yoko
authors.initials: Y
authors.lastname: Yokoyama
authors.affiliation: Department of Inflammatory Bowel Disease, Hyogo College of Medicine, Nishinomiya, Kakogawa, Japan.
authors.forename: Shiro
authors.initials: S
authors.lastname: Nakamura
authors.affiliation: Department of Gastroenterology, Kakogawa West City Hospital, Kakogawa City Hospital Foundation, Kakogawa, Japan.
authors.forename: Yuko
authors.initials: Y
authors.lastname: Nakamura
authors.affiliation: Division of Infection Control and Prevention, Hyogo College of Medicine, Nishinomiya, Kakogawa, Japan.
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Takesue
keywords: Cesarean section; Colectomy; Pregnancy; Surgical procedure; Ulcerative colitis