Lower abdominal pain during pregnancy due to small bowel perforation: a case of Crohn’s disease requiring differentiation from obstetric disorders

Abstract

A 36-year-old female (gravida 1, para 0) had persistent anemia since early pregnancy in an otherwise normal course of pregnancy. She visited our department with a complaint of abdominal pain at 37 weeks 2 days of gestation. Her pain was initially accompanied by uterine contractions but later appeared independently. Fever and fetal tachycardia with decelerations were also observed. Abdominal ultrasound revealed fluid accumulation in the abdominal cavity, and an emergency cesarean section was performed with suspicion of placental abruption and imminent uterine rupture. A small amount of intestinal fluid was found in the abdominal cavity, leading to a diagnosis of peritonitis due to small intestinal perforation. A female infant weighing 2,560 g was delivered (Apgar score: 9; umbilical artery pH: 7.278). The patient underwent resection of the perforated portion of the small intestine and ileostomy. Postoperative pathological examination revealed Crohn’s disease. The patient was discharged after surgery and is undergoing remission induction therapy and nutritional therapy for Crohn’s disease.