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  • Title: Fever and right upper quadrant pain in a pregnant woman at 30 weeks' gestation.
    Author: Harrell LE, Rubin DT, Hanauer SB.
    Journal: Nat Clin Pract Gastroenterol Hepatol; 2004 Dec; 1(2):113-6; quiz 1 p following 116. PubMed ID: 16265073.
    Abstract:
    BACKGROUND: A 34-year-old gravid woman with a history of ileal Crohn's disease presented at 30 weeks' gestation with a 2-week history of fever and right upper quadrant pain. An intra-abdominal abscess was suspected. Ultrasound and MRI failed to demonstrate the suspected abscess. Owing to ongoing pain and fever, the risk to the fetus of a CT scan were discussed with the patient, obstetricians and radiologists, with considerable debate about the possibility of other explanations for her symptoms. Ultimately, a CT scan revealed marked thickening of the distal ileum and confirmed diagnosis of an abscess in continuity with the inflamed bowel. INVESTIGATIONS: Ultrasound, MRI, CT scan, urinalysis, urine culture and liver function tests. DIAGNOSIS: Crohn's disease flare complicated by an intra-abdominal abscess. MANAGEMENT: Antibiotics (ceftizoxime, metronidazole and amoxicillin/clavulanate potassium), parenteral nutrition and ileocecectomy.
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