Ischemic Colitis Secondary to Ileocolic Artery Thrombosis in the Context of Active Ulcerative Colitis During Pregnancy: A Case Report and Review of the Literature

Ulcerative colitis (UC) during pregnancy poses diagnostic and therapeutic challenges due to symptom overlap with normal pregnancy physiology and the maternal-fetal risks associated with active inflammation. We present the case of a 24-year-old woman with a prior diagnosis of UC who discontinued treatment after finding out she was pregnant. At 22 weeks of gestation, she began experiencing abdominal pain and bloody diarrhea. Magnetic resonance imaging revealed thickening of the terminal ileum, ascending and transverse colon, with microhemorrhages, along with severe anemia and hemodynamic instability. The patient's condition worsened, presenting signs of peritoneal irritation. An urgent laparotomy was performed, including partial ileectomy, right colectomy, and end ileostomy. Twelve hours after the procedure, intrauterine fetal demise was confirmed. Histopathological examination revealed ischemic colitis with Ileocolic arterial thrombosis, a rare complication of the disease that carries a high morbidity and mortality rate, and is scarcely documented in the medical literature. Although no medical therapy completely eliminates the risk of flare-ups and complications, good adherence to treatment has been shown to achieve complication rates similar to those of non-pregnant women. This case highlights the importance of strict management of Inflammatory bowel disease during pregnancy and the need to avoid discontinuing maintenance therapy due to unfounded concerns about teratogenicity.