Inflammatory bowel disease and its impact on fertility and pregnancy

The peak age of onset of inflammatory bowel disease [IBD] is simultaneous with the peak reproductive years. Patients have many concerns about the impact of IBD on fertility and pregnancy outcomes. The most important reason for voluntary childlessness is the fear of side effects from medications for IBD. Decision making for medical therapy is a complex equation. It is important to summarize available information about the management of IBD during pregnancy and its interactions. Among IBD patients, those undergoing surgery are at risk for reductions in fertility. Patients with ileal pouches-anal anastomosis [IPAA] experience higher rates of infertility. Disease activity at the time of conception is the main determinant of the impact of IBD on adverse pregnancy outcomes. In different nations, disease activity and relapse depend on many factors and may even be slightly lower during pregnancy. The recommended mode of delivery in IBD is still controversial. However, there is an increased rate of cesarean sections in women with IBD. Choosing the appropriate method of delivery should be based on the obstetrician's opinion, however active perianal disease and the presence of an ileoanal pouch are two major exceptions. If women remain on their maintenance therapy, there would be no increased risk of a flare-up during the postpartum period. In most patients, maintaining remission with medication outweighs the risks of their adverse effects. However, the pros and cons must be discussed with the patient and decisions should be made on an individual basis. Among all drugs used in IBD treatment, only methotrexate [MTX] and thalidomide are contraindicated in pregnancy

Report of a documented case of encapsulating peritoneal sclerosis in Iran

Encapsulating peritoneal sclerosis [EPS] is a rare, acquired condition that has been described interchangeably with peritoneal encapsulation [PE] as well as abdominal cocoon. EPS causes complications for peritoneal dialysis [PD] patients. In EPS, the small intestine is covered by a fibrotic and inflammatory peritoneal capsule that either partially or completely encases the bowel. For EPS, there is no agreement in the literature as to whether the treatment of choice should be surgery or conservative therapy. However in the obstructive phase the treatment of choice is surgery due to the impossibility of conservative treatment. Here, we report the case of a 64-year-old woman who presented with several episodes of intestinal obstruction and peritonitis. Computed tomography [CT] of the abdomen did not show significant characteristic features of EPS. Exploratory laparotomy was performed, freeing the small bowel of adhesions and encapsulation. For EPS, adequate clinical knowledge and a high degree of suspicion are crucial for a correct diagnosis and appropriate management

[Causal association between isotretinoin and inflammatory bowel disease: a case report]

Roaccutane[R] [isotretinoin] is used for the treatment of severe forms of acne resistant to adequate standard therapy. Inflammatory bowel disease [IBD] is described as a possible adverse drug reaction in the product information of isotretinoin. In a case study, we report the case of a 30 year old woman with a history of bloody diarrhea, abdominal pain and severe folliculitis/acne which had been treated with isotretinoin. Her clinical features worsened whilst on isotretinoin. Colonoscopy demonstrated diffuse ulcerative pancolitis. Isotretinoin treatment was discontinued and the patient was prescribed 5-aminosalicylic acid and corticosteroids. After a few months, steroids were discontinued and the patient went into clinical and laboratory remission. Evaluation of the possible causal association between isotretinoin treatment and IBD suggested a probable relationship, which should lead to considerable caution while prescribing this drug