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Therapy of complicated Crohn’s disease during pregnancy—an interdisciplinary challenge

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International Journal of Colorectal Disease Aims and scope Submit manuscript

Abstract

Background

Severe courses of Crohn’s disease (CD) during pregnancy are rare. However, if occurring, the risk of miscarriage and low birth weight is increased. At present, only limited data is available on the treatment of CD during pregnancy. In particular, there are no standard guidelines for surgical therapy. Nevertheless, surgery is often unavoidable if complications during the course of the disease arise.

Purpose

This study provides a critical overview of conventional and interventional treatment options for CD complications during pregnancy and analyses the surgical experience gained thus far. For illustrative purposes, clinical cases of three young women with a severe clinical course during pregnancy are presented.

Methods

After treatment-refractory for conservative and interventional measures, surgery remained as the only treatment option. In all cases, a split stoma was created after resection to avoid anastomotic leaks that would endanger the lives of mother and child. The postoperative course of all three patients was uneventful, and pregnancy remained intact until delivery. No further CD specific medication was required before birth.

Conclusions

The management of CD patients during pregnancy requires close interdisciplinary co-operation between gastroenterologists, obstetricians, anaesthetists and visceral surgeons. For the protection of mother and child treatment should thus be delivered in a specialised centre. This article demonstrates the advantages of surgical therapy by focusing on alleviating CD complaints and preventing postoperative complications.

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Acknowledgments

The authors thank Susann Power for translational support of the manuscript.

Author information

Authors and Affiliations

  1. Department of General, Visceral and Vascular Surgery, Charité – Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Germany

    C. Seifarth & H. J. Buhr

  2. Center of General and Visceral Surgery, Helios Kliniken, Schwerin, Germany

    J. P. Ritz

  3. Department of General, Visceral and Vascular Surgery, Ortenau Klinikum, Offenburg-Gengenbach, Germany

    U. Pohlen

  4. Department of Gereral, Visceral Surgery and Traumatology, Krankenhaus Porz am Rhein, Koeln, Germany

    A. J. Kroesen

  5. Department of Gastroenterology, Rheumatology and Infectious Diseases, Charité – Universitätsmedizin Berlin, Berlin, Germany

    B. Siegmund

  6. Department of Radiology, DRK Klikum Westend, Berlin, Germany

    B. Frericks

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  1. C. Seifarth
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  2. J. P. Ritz
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  3. U. Pohlen
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  4. A. J. Kroesen
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  5. B. Siegmund
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  7. H. J. Buhr
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Correspondence to C. Seifarth.

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Seifarth, C., Ritz, J.P., Pohlen, U. et al. Therapy of complicated Crohn’s disease during pregnancy—an interdisciplinary challenge. Int J Colorectal Dis 29, 645–651 (2014). https://doi.org/10.1007/s00384-014-1880-4

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  • DOI: https://doi.org/10.1007/s00384-014-1880-4

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