Crohn's disease: "its gynecologic aspect"

An analysis of the medical records of 103 women with Crohn's disease points up the following observations. There is a slight increase in spontaneous abortions and a substantial degree of subfertility. The obstetric experience is the same as in the normal obstetric population and the effects of the disease on pregnancy and of pregnancy on the disease are minimal. Features seemingly unrelated to Crohn's disease and of a gynecologic nature may be present months before the onset of the main bowel inflammation. These features consist of abscesses, fistulas, ulcers, fissures, and infections involving not only the internal pelvic organs but also the vulvovagina, perineum, labia, rectovaginal septum, rectum, and anus. The onset of Crohn's disease may be acute and present the picture of an abdomen requiring surgical treatment. A tender, low abdominal, adnexal, or pelvic mass may incorrectly be diagnosed as acute appendicitis, pelvic inflammatory disease, or ovarian cyst, and lead to surgery. In 23 instances the diagnosis of Crohn's disease was established only after laparotomy. A total of 27 appendectomies were performed and none of these patients had acute appendicitis. Four pelvic abscesses developed after the appendectomies. To avoid the pitfalls of misdiagnosis and mismanagement, the nature of Crohn's disease should be understood and the gynecologic aspects of the disease recognized.