Ileal pouch perforation in pregnancy: report of a case and review of the literature

Acute abdominal pain, especially in the presence of free intra-abdominal air, in a pregnant patient who has previously undergone ileal pouch-anal anastomosis may be a result of acute perforation of the pouch. The case of a 30-year-old multigravida with an uncomplicated pregnancy at 27 weeks gestation who was admitted to the perinatal ward for preterm labor is described. The patient's past medical history was significant for an ileal pouch-anal anastomosis for ulcerative colitis. Forty-eight hours after admission, she acutely developed generalized abdominal pain with associated dyspnea. A spiral CT of the chest to rule out pulmonary embolus revealed free intra-abdominal air. An emergency cesarean section was performed, which resulted in a viable female infant. The etiology for the free air was a perforation of the ileal pouch secondary to adhesions to the posterior part of the uterus. Perforation of the pouch has been reported secondary to a variety of factors. However, no cases of ileal pouch perforation in pregnancy have been reported. Adhesions that involve the pouch and an enlarged contracting uterus may result in perforation of the pouch. Awareness and knowledge of this potential complication may lead to earlier recognition and optimal management.