Fever and right upper quadrant pain in a pregnant woman at 30 weeks' gestation.

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.