Perforated Crohn's disease presenting during pregnancy

Severe exacerbations of Crohn's disease (CD) requiring acute surgery are rare, and rarer still are those that occur during pregnancy. We present a case of perforated CD in an obstetric patient. A 24-year-old woman at 27 weeks gestation, with abdominal pain, leucocytosis and concern for preterm labour, presented to our institution. MRI was obtained and demonstrated a phlegmon in the small bowel mesentery near the distal ileum, with concern for perforation. The patient was taken for an emergent exploratory laparotomy. Intraoperatively, an ileal perforation with small bowel fistula was observed and an ileocolectomy with primary anastomosis was performed. Pathology of the resection revealed CD, a new diagnosis for the patient. She was ultimately discharged on postoperative day 13 and later went on to deliver a healthy term infant, and, 5 years later, has had no significant recurrence.