2022 Volume 55 Issue 8 Pages 529-535
A 25-year-old woman with abdominal pain and diarrhea visited her local doctor and was diagnosed with ulcerative colitis. The inflammation went into remission after administration of prednisolone, but flared four months later. She was referred to our hospital because she subsequently became pregnant. The patient was diagnosed with total-colon type ulcerative colitis, Matts grade 4, and did not respond to infliximab and granulocyte-removal therapy; therefore, we decided that surgery was indicated. To ensure the safety of the mother and child, a three-stage divided surgery was planned. At 14 weeks of gestation, laparoscopic subtotal colon resection, ileal stoma, and fixation of the sigmoid colon to the abdominal wall were performed. At 3 months after a normal delivery (41 weeks of gestation, birth weight 2,665 g), the patient underwent laparoscopic total resection of the remaining colon, ileal pouch-anal anastomosis, and reconstruction of the ileal stoma. Finally, the ileal stoma was closed 6 months later. In this case, laparoscopic surgery was chosen after consultation with anesthesiologists, and the technique was devised to ensure safe continuation of pregnancy.
