title: Fulminant ulcerative colitis in a healthy pregnant woman.
abstract: This case report concerns a 25-year-old patient with 6-7 bloody stools/d, abdominal pain, tachycardia, and weight loss occurring during the third trimester of pregnancy. Severe ulcerative colitis complicated by toxic megacolon and gravidic sepsis was diagnosed by clinical evaluation, colonoscopy, and rectal biopsy that were performed safely without risk for the mother or baby. The patient underwent a cesarean section at 28+6 wk gestation. The baby was transferred to the neonatal intensive care unit of our hospital and survived without complications. Fulminant colitis was managed conservatively by combined colonoscopic decompression and medical treatment. Although current European guidelines describe toxic megacolon as an indication for emergency surgery for both pregnant and non-pregnant women, thanks to careful monitoring, endoscopic decompression, and intensive medical therapy with nutritional support, we prevented the woman from having to undergo emergency pancolectomy. Our report seems to suggest that conservative management may be a helpful tool in preventing pancolectomy if the patient's condition improves quickly. Otherwise, surgery is mandatory.
authors.affiliation: Rossana Orabona, Adriana Valcamonico, Tiziana Frusca, Maternal Fetal Medicine Unit, Department of Obstetrics and Gynecology, University of Brescia, 25123 Brescia, Italy.
authors.forename: Rossana
authors.initials: R
authors.lastname: Orabona
authors.affiliation: Rossana Orabona, Adriana Valcamonico, Tiziana Frusca, Maternal Fetal Medicine Unit, Department of Obstetrics and Gynecology, University of Brescia, 25123 Brescia, Italy.
authors.forename: Adriana
authors.initials: A
authors.lastname: Valcamonico
authors.affiliation: Rossana Orabona, Adriana Valcamonico, Tiziana Frusca, Maternal Fetal Medicine Unit, Department of Obstetrics and Gynecology, University of Brescia, 25123 Brescia, Italy.
authors.forename: Marianna
authors.initials: M
authors.lastname: Salemme
authors.affiliation: Rossana Orabona, Adriana Valcamonico, Tiziana Frusca, Maternal Fetal Medicine Unit, Department of Obstetrics and Gynecology, University of Brescia, 25123 Brescia, Italy.
authors.forename: Stefania
authors.initials: S
authors.lastname: Manenti
authors.affiliation: Rossana Orabona, Adriana Valcamonico, Tiziana Frusca, Maternal Fetal Medicine Unit, Department of Obstetrics and Gynecology, University of Brescia, 25123 Brescia, Italy.
authors.forename: Guido A M
authors.initials: GA
authors.lastname: Tiberio
authors.affiliation: Rossana Orabona, Adriana Valcamonico, Tiziana Frusca, Maternal Fetal Medicine Unit, Department of Obstetrics and Gynecology, University of Brescia, 25123 Brescia, Italy.
authors.forename: Tiziana
authors.initials: T
authors.lastname: Frusca
mesh_terms: D000328:Adult; D001706:Biopsy; D002585:Cesarean Section; D003093:Colitis, Ulcerative / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D003113:Colonoscopy; D019299:Decompression, Surgical / Q000379:methods; D005260:Female; D005865:Gestational Age; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008532:Megacolon, Toxic / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D011263:Pregnancy Trimester, Third; D047928:Premature Birth; D018805:Sepsis / Q000175:diagnosis / Q000209:etiology*; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents
keywords: Cesarean section; Colonoscopy; Pregnancy; Toxic megacolon; Ulcerative colitis