炎症性腸疾患と障害のジャーナル

The incidence and prevalence of Crohn's disease (CD) in adolescents is rising. The clinical course differs in several aspects from that of adults. Pediatric-onset disease is more extensive and its course is somewhat more aggressive. In addition to the common manifestation of CD, adolescents with CD may present with pubertal delay, growth retardation and osteopenia. These unique aspects of adolescence CD should impact the treatment paradigm. In cases of growth impairment and osteopenia, treatment should be intensive aiming at promoting complete mucosal healing and, in turn, improved growth and bone formation. The use of enteral nutrition should be thus encouraged both for induction and maintenance of remission. However, adolescent CD carries implications that go beyond the physical manifestations of the disease. Children diagnosed with IBD are at increased risk of emotional distress and decreased social functioning. The use of support groups and other psychosocial interventions is advocated as a mean to enhance coping skills and improve quality of life. As many as half of adolescents are non-compliant with the recommended treatment hence, a particular emphasis should be placed on engaging the adolescent in the treatment plan, using several intervention strategies. Adolescence is a time of dynamic physical changes and growth along with emotional maturation. This review highlights some of the unique aspects that should come into play while managing CD during this sensitive period of life.

Background: A new diagnosis of Crohn disease during pregnancy is uncommon. Intra-abdominal abscess as an initial feature of Crohn disease during pregnancy is rare.

Case: A 26-year-old healthy primigravida woman at 33 weeks of gestation presented with abdominal pain and an abdominal mass. Labor was induced at 37 weeks to expedite postpartum evaluation. On postpartum day 2 she developed septic shock and multiorgan failure. Emergent exploratory laparotomy revealed an intra-abdominal abscess involving the right colon and terminal ileum. Pathology was consistent with Crohn’s disease.

Conclusion: Intra-abdominal abscess from Crohn’s disease is a rare occurrence during pregnancy and may be associated with significant maternal morbidity. When diagnosis in the postpartum period is uncertain and the differential diagnosis includes Crohn’s disease or abscess, early postpartum evaluation may prevent complications.

Pelvic Organ Prolapse (POP) can be defined as a downward descent of female pelvic organs, including the bladder, uterus, post-hysterectomy vaginal cuff and the small or large bowel, resulting in protrusion of the vaginal walls, uterus, or both. The International Continence Society includes also rectal prolapses. POP development is multifactorial.