Pelvic Abscess with Initial Presentation of Crohn’s Disease in Pregnancy Leading to Maternal Sepsis

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.