Supplementary Material for: A patient with Crohn’s disease who gave birth despite sigmoid volvulus, venous thrombosis, non-traumatic fracture of the rib, and sepsis during pregnancy

The patient was a woman in her 40s who was diagnosed with Crohn’s disease (CD) of the large and small intestines in 1996. In 2005, she was referred to our hospital for treatment. We treated her for 17 years with corticosteroids, biologics, immunosuppressive agents, 5-aminosalicylic acid, and nutrition care. However, her Crohn’s Disease Activity Index remained between 200 and 250, indicating refractory CD. During her medical treatment, the patient also underwent 3 operations. One year ago, the patient became pregnant through in vitro fertilization. Even after pregnancy was confirmed, the patient continued her treatment for refractory CD with ustekinumab, granulocyte apheresis, and budesonide. Nonetheless, her CD was highly active during pregnancy, and she experienced various complications: sigmoid volvulus at gestational week 15, venous thrombosis at gestational week 17, non-traumatic rib fracture due to fetal movement at gestational week 32, and sepsis from central venous catheter infection at gestational week 37. At gestational week 38, the patient gave birth by emergency cesarian delivery. This paper reports details of the case in which delivery was achieved after various complications were overcome and discusses previous relevant reports.本例患者为一名40余岁女性，于1996年被确诊为大肠及小肠克罗恩病（Crohn’s disease, CD）。2005年，该患者转诊至本院接受治疗。本院为其实施了长达17年的综合治疗，方案涵盖糖皮质激素（corticosteroids）、生物制剂（biologics）、免疫抑制剂（immunosuppressive agents）、5-氨基水杨酸（5-aminosalicylic acid）及营养支持干预。但其克罗恩病活动指数（Crohn’s Disease Activity Index）始终维持在200~250之间，提示为难治性克罗恩病。在治疗期间，该患者还先后接受了3次手术。1年前，该患者通过体外受精（in vitro fertilization）成功受孕。即便确诊妊娠后，患者仍继续接受针对难治性克罗恩病的治疗，所用方案包括乌司奴单抗（ustekinumab）、粒细胞单采术（granulocyte apheresis）及布地奈德（budesonide）。然而，患者妊娠期间克罗恩病仍处于高度活动状态，并出现多种并发症：妊娠15周时发生乙状结肠扭转，妊娠17周时出现静脉血栓，妊娠32周时因胎动引发非创伤性肋骨骨折，妊娠37周时因中心静脉导管感染引发脓毒症。妊娠38周时，患者接受急诊剖宫产术顺利分娩。本文详细报告该患者克服多种并发症后成功分娩的病例，并对相关既往文献进行探讨。