Case Report: A unique case of a retroperitoneal abscess during pregnancy complicated with an ileo-sigmoid-vesical fistula in a patient with active Crohn’s disease

Ghizlane Bendriss,Zafer Esmandar

doi:10.12688/f1000research.23636.1

Ghizlane Bendriss, Zafer Esmandar

Open Access

https://doi.org/10.12688/f1000research.23636.1

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Abstract

The enterovesical fistula is an uncommon condition resulting from complications of inflammatory diseases such as Crohn’s disease. While erosion of an abscess can result in the formation of enterovesical fistula, early diagnosis of abscesses is crucial in order to avoid complications. This case is a retrospective analysis of the unusual combination of events that contributed to the misdiagnosis, further complications in a pregnant 28-year-old female diagnosed with Crohn’s disease. The patient presented a retroperitoneal abscess, which went undiagnosed and complicated with an ileo-sigmoid-vesical fistula during pregnancy. She complained of right sciatica, cruralgia, and a complete inability to lift her right leg as well as recurrent urinary infections, which were treated by multiple courses of antibiotics. The chronic situation led to the restricted growth of the fetus, which made the fetus not tolerate the labor. Emergency C-section was done due to fetal distress, but baby did well and did not need NICU. None of the gynecological examinations, ultrasound, X-ray, CT-scan, cystography, and colonoscopy performed before, during and after pregnancy were able to explain her symptoms. Fecaluria is the symptom that ultimately directed toward the presence of an eventual fistula five months after delivery. The MRI diagnosed the retroperitoneal abscess and an ileo-sigmoid-vesical fistula, which were treated by total parenteral nutrition followed by ileo-colo resection. An ileostomy was maintained for four months before anastomosis. Sciatic pain and psoasitis in a context of Crohn’s disease should alert physicians to the possible presence of a retroperitoneal abscess, which should be monitored by MRI. In addition, recurrent urinary infections during pregnancy in a context of Crohn’s disease can be sign of a formed enterovesical fistula. The multiple antibiotic courses, while allowing the continuity of the pregnancy, also contributed to further delay of diagnosis by decreasing inflammation.

Highlights

Enterovesical fistulae are uncommon conditions that are most commonly diagnosed based on clinical evidence
Our retrospective analysis of the events is that a retroperitoneal abscess was formed in February 2011, which resulted in psoasitis, which explains both sciatica and crualgia
X-ray and CT-scan were not possible during pregnancy, and urinary infection and sciatic pain were attributed to pregnancy

Summary

Introduction

2. Your reference 1 concerning the incidence and rate of fistulas for Crohn’s patients is a case report, it does not seem plausible that this is the most accurate reference – please consider revising the reference. 3. Please add a verb in the sentence: “One of the mechanisms of the formation of an enterovesical fistula the erosion of an abscess”. Case report: patient information and clinical findings 1. What year was she diagnosed with Crohn’s disease?. 3. Was abdominal stiffness a symptom reported by the patient or a finding of repeated clinical examinations?. In February and March, there were clinical findings in relation to her right kidney – was there really no information on her urine at these appointments?. The sentence should be revised – there are no descriptions of scans that show inflammation of the ileum.

Discussion

Specific Carbohydrate Diet

Findings