Abstract
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.
Investigations Ultrasound, MRI, CT scan, urinalysis, urine culture and liver function tests.
Diagnosis Crohn's disease flare complicated by an intra-abdominal abscess.
Management Antibiotics (ceftizoxime, metronidazole and amoxicillin/clavulanate potassium), parenteral nutrition and ileocecectomy.
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Glossary
- MESALAMINE
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An aminosalicylate used for the treatment of mild to moderate inflammatory bowel disease
- MERCAPTOPURINE
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A thiopurine analog and immunomodulatory agent used in the management of inflammatory bowel disease
- CEFTIZOXIME
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A third generation cephalosporin with enhanced activity against Gram-negative rods
- METRONIDAZOLE
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An antiprotozoal drug used in the treatment of Trichomonas spp., Giardia spp. and amebic infections; it is also effective in the treatment of anaerobic bacterial infections
- AMOXICILLIN/CLAVULANATE POTASSIUM
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A broad spectrum antibiotic consisting of amoxicillin combined with clavulanic potassium, which is a beta-lactamase inhibitor
- PREGNANCY CATEGORY B
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The category to which an agent is assigned after assessment of the risk of fetal injury, for which the safety is based on animal studies
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Harrell, L., Rubin, D. & Hanauer, S. Fever and right upper quadrant pain in a pregnant woman at 30 weeks' gestation. Nat Rev Gastroenterol Hepatol 1, 113–116 (2004). https://doi.org/10.1038/ncpgasthep0037
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DOI: https://doi.org/10.1038/ncpgasthep0037
