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Maternal and Fetal Outcome After Colectomy for Fulminant Ulcerative Colitis During Pregnancy: Case Series and Literature Review

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Diseases of the Colon & Rectum

Purpose

Previous studies have reported high morbidity and mortality in mothers and their offspring after colectomy for ulcerative colitis during pregnancy. This study was designed to assess the maternal and fetal outcomes of pregnant females undergoing colectomy for ulcerative colitis in the current era.

Methods

A retrospective analysis was performed at our institution of all pregnant females undergoing operation for ulcerative colitis between 1980 and 2004. To compare this data to that of past literature, a MEDLINE search from 1951 to 2004 reviewed all cases reported on this topic.

Results

Between 1980 and 2004, five females underwent an operation at our institution for fulminant ulcerative colitis while pregnant. All five patients underwent subtotal colectomy with Brooke ileostomy. Postoperative maternal morbidity included a superficial wound infection and a small asymptomatic intra-abdominal abscess. All females had successful pregnancies, and no maternal or fetal deaths occurred. Two patients went on to have an ileal pouch-anal anastomosis, one had a completion proctectomy and end ileostomy, oneis scheduled for an ileal pouch-anal anastomosis, andone patient is lost to follow-up. The literature review revealed 37 cases. The overall fetal and maternal mortality was 49 and 22 percent respectively. Postoperative maternal morbidity was reported in 24 percent.

Conclusions

In contrast to historic data, the maternal and fetal mortality from our series was zero and maternal morbidity was low. Subtotal colectomy and Brooke ileostomy for ulcerative colitis during pregnancy is safe. A multidisciplinary team that includes a gastroenterologist, high-risk obstetrician, and experienced surgeon is necessary for an optimal outcome.

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Authors and Affiliations

  1. Division of Colon and Rectal Surgery, Mayo Clinic, 200 First Street SW, Rochester, Minnesota, 55905, USA

    Eric J. Dozois M.D. & Bruce G. Wolff M.D.

  2. Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA

    William J. Tremaine M.D.

  3. Division of Obstetrics and Gynecology, Mayo Clinic College of Medicine, Rochester, Minnesota, USA

    William J. Watson M.D.

  4. Colon and Rectal Surgery, University of Alabama, Birmingham, Alabama, USA

    Ernesto R. Drelichman M.D.

  5. Department of Surgery, Cabrini Monash University, Cabrini Hospital, Melbourne, Victoria, Australia

    Peter W. G. Carne M.B.B.S.

  6. Department of Nursing, Mayo Clinic College of Medicine, Rochester, Minnesota, USA

    Julie L. Bakken R.N.

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  1. Eric J. Dozois M.D.
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  2. Bruce G. Wolff M.D.
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  3. William J. Tremaine M.D.
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  4. William J. Watson M.D.
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  5. Ernesto R. Drelichman M.D.
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  6. Peter W. G. Carne M.B.B.S.
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  7. Julie L. Bakken R.N.
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Correspondence to Eric J. Dozois M.D..

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Dozois, E.J., Wolff, B.G., Tremaine, W.J. et al. Maternal and Fetal Outcome After Colectomy for Fulminant Ulcerative Colitis During Pregnancy: Case Series and Literature Review. Dis Colon Rectum 49, 64–73 (2006). https://doi.org/10.1007/s10350-005-0210-x

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