Free Perforation of Ileum Due to Crohn's Disease -Report of a Case-

Masayoshi Nishina, Ryuko Ogino, Chiiho Fujii

Department of Acute Medicine, Kawasaki Medical Shool

A 42-years-old man was admitted to our service with acute onset of severe abdominal pain. His past medical history revealed that he had been on prednisolone and salazosulfapyridine for 11 years under the diagnosis of Crohn's disease, and an ileal stenosis secondary to the Crohn's disease was detected by radiological studies six years before admission. However the stenosis had been kept under observation by medical management since there was no definite sign of small bowel obstruction. On admission an initial evaluation of the patient yielded the picture of an acute abdomen due to a perforated viscus. Therefore an emergency laparotomy was performed and revealed a free perforation of the dilated ileum which was located on the antimesenteric side and proximal to the stenosis. A macroscopically pathologic segment of the small bowel was resected and a primary anastomosis was formed. The resected specimen showed stenosis and longitudinal ulcers which are consistent with Crohn's disease. Microscopic examination revealed inflammatory cell infiltration and granuloma formation. The postoperative course was uneventful and the patient was discharged on the 62nd hospital day. This case suggests that one must keep in mind the possibility of free perforation of the intestine due to Crohn's disease during long-term medical care of the disease.

Key words
free perforation of regional enteritis, Crohn's disease

Reprint requests
Masayoshi Nishina Department of Acute Medicine, Kawasaki Medical School
577 Matsushima, Kurashiki-City, 701-01 JAPAN

Accepted
November 20, 1991

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