Cesarean Delivery After Multiple Prior Intraperitoneal Surgeries: A Case Report in a Patient With Crohn Disease

BACKGROUND The mode of delivery in women with inflammatory bowel disease (IBD), including Crohn disease, requires individualized multidisciplinary assessment. Prior abdominal surgery increases the risk of intra-abdominal adhesions and operative complications. The extraperitoneal French Ambulatory Cesarean Section (FAUCS) technique may help avoid peritoneal entry in selected patients with complex surgical histories. This report describes the feasibility and short-term perioperative outcome of FAUCS in a patient with multiple prior intraperitoneal surgeries. Crohn disease is presented as a relevant comorbidity rather than the primary operative indication. CASE REPORT We report the case of a 25-year-old woman with Crohn disease and a history of 5 prior intraperitoneal surgical procedures, including bilateral hemicolectomy, colostomy formation, appendectomy, and adhesiolysis. The pregnancy was achieved through in vitro fertilization and remained uncomplicated, with Crohn disease in sustained clinical remission. No preoperative imaging was performed; the likelihood of adhesions was inferred from multiple laparotomies and previous adhesiolysis. Due to anticipated extensive intra-abdominal adhesions, elective cesarean delivery using the extraperitoneal FAUCS technique was performed under an enhanced recovery after cesarean (ERAC) pathway. A healthy male neonate was delivered at 37 weeks of gestation, weighing 2550 g (Apgar score 10 at 5 minutes). Postoperative recovery was uncomplicated, with early oral intake, mobilization, minimal analgesic requirements, and no postoperative complications. CONCLUSIONS This case documents the feasibility and perioperative outcomes of extraperitoneal FAUCS in a rare scenario involving multiple prior intraperitoneal surgeries and Crohn disease in remission. It is intended to support clinician awareness and case-based learning rather than establish safety or efficacy claims.