Cesarean Delivery After Multiple Prior Intraperitoneal Surgeries: A Case Report in a Patient With Crohn Disease.
Daniel Wolder, Agata Michalska, Jagoda Zakrzewska et al.
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Case in brief
A 25-year-old woman with Crohn disease in sustained remission had an uncomplicated pregnancy after in vitro fertilization. Her history included five intraperitoneal operations, including bilateral hemicolectomy, colostomy formation, appendectomy, and adhesiolysis; adhesions were anticipated from this history, without preoperative imaging. She underwent elective cesarean delivery using the extraperitoneal French Ambulatory Cesarean Section technique within an enhanced recovery pathway. A healthy male infant was delivered at 37 weeks, weighing 2550 g, with an Apgar score of 10 at 5 minutes. Maternal postoperative recovery was uncomplicated.
What made this case unusual
The report describes use of an extraperitoneal cesarean technique in a patient with multiple prior intraperitoneal operations and anticipated extensive adhesions; Crohn disease was in remission and was not the operative indication.
Diagnostic / clinical pearl
A history of multiple laparotomies and adhesiolysis can inform anticipation of adhesions even when preoperative imaging is not performed; this case documents the feasibility of an extraperitoneal approach in that setting.