Refractory Inflammatory Bowel Disease in Pregnancy: Multidisciplinary Management With Timely Surgery and Ultrasound Monitoring

ABSTRACT

Management of medically refractory inflammatory bowel disease during pregnancy remains challenging due to limited evidence regarding rescue therapy, surgical timing, and fetal safety. We report a case of third-trimester inflammatory bowel disease-unclassified treated with accelerated infliximab rescue therapy and serial intestinal ultrasound monitoring. Persistent clinical, biochemical, and sonographic disease activity despite intensive medical therapy prompted multidisciplinary decision making, culminating in combined lower segment caesarean section and left hemicolectomy at 33+6 weeks gestation. This case highlights the value of multidisciplinary care and serial intestinal ultrasound as an adjunctive objective tool to support therapeutic escalation and surgical decision making in pregnancy.