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Abstract
Introduction/Background Chronic, severe, active Crohn’s disease in a young patient creates surgical complexity with fertility considerations. The rarity of the presentation of intractable pelvic abscesses within this aetiology and their requirement for input from a multi-disciplinary team makes this a vital case in building a consensus for evidence-based management of gynaecological surgery.
Methodology A 29-year-old nulliparous woman was referred to our tertiary centre for consideration of surgical management of Crohn’s disease with known tubo-ovarian abscess and abdominoperineal sinuses, with subsequent renal impairment requiring stenting. Her previous surgical history included 4 midline laparotomies, bowel perforation, subtotal colectomy and proctectomy with stoma formation and reformation and a bilateral salpingectomy.
Results The patient first underwent egg collection to preserve fertility. This was followed by a midline laparotomy and abdominoperineal resection, which involved an anterior colpotomy and a retrograde modified Hudson hysterectomy, alongside refashioning of the ileostomy. Excision and drainage of the abdominal wall abscess was performed alongside excision of the perineal sinus, with reconstruction of the perineal defect using an internal pudendal artery perforator gluteal fold flap. Involvement was sought from gynaecological oncology, colorectal, urology, plastics, stoma, fertility, microbiology, and gastroenterology teams to ensure continued patient optimisation. This multi-disciplinary collaboration resulted in successful preservation of end organ function and improvement in patient psychological well-being.
Conclusion We present this case as a paradigm of surgical challenge, requiring expert gynaecological oncology techniques including retroperitoneal approach, nerve and vessel sparing considerations alongside colorectal and urological procedures. Collaboration and communication between teams allowed us to provide patient-centred care which preserved quality of life. In addition to our novel combination of surgical techniques, we believe that our blueprint for effective multi-disciplinary practice will inform future management of gynaecological oncological surgery.