Toxic megacolon during pregnancy in ulcerative colitis: A case report

• Ulcerative colitis has a peak incidence which coincides with the childbearing age of females.
• Acute fulminant colitis during pregnancy is rare, but requires mandatory surgical colectomy which carries a significant risk to both mother and fetus.
• We recommend that female patients planning to conceive with a known diagnosis of ulcerative colitis have an optimised medical regimen by liaising with their obstetricians and gastroenterologists to prevent exacerbations and the development of toxic megacolon.
• Should surgical intervention become required, this can be performed with favourable outcomes for mother and child as demonstrated in this report.

IntroductionUlcerative colitis is an idiopathic inflammatory bowel condition whose peak incidence coincides with fertility in female patients. In pregnancy, acute fulminant colitis is rare, and, when it becomes refractory to maximum medical therapy, emergency colectomy is mandated. Over the past quarter century, there have been few reports of this rare event in the literature.Presentation of caseWe report a 26 year old primigravida female who presented with toxic megacolon during the third trimester of pregnancy, unresponsive to medical therapy. She subsequently underwent an urgent low transverse caesarean section with a total colectomy. Both mother and child made a satisfactory recovery post operatively.DiscussionAlthough the fetus is at higher risk than the mother in such a circumstance, morbidity and mortality rates are still noticeably high for both, and therefore, prompt diagnosis is key.ConclusionIt is imperative that female patients planning to conceive with a known diagnosis of ulcerative colitis liaise with their obstetricians and gastroenterologists early to optimise medical treatment to prevent the development of a toxic megacolon and that conception is planned during a state of remission. Should surgical intervention become required, this can be performed with favourable outcomes for mother and child, as demonstrated in this report.