An Elderly Case of Crohn's Disease in Association with Perforation of the Ileum

Yuji Tanaka, Masaru Murakami, Toshiaki Oishi, Hajime Kishimoto*

Department of Surgery, Tenryu Byoin National Sanatorium
*Department of Internal Medicine, Tenryu Byoin National Sanatorium

A 78-year-old man had Crohn's disease complicated by peritonitis due to bowel perforation. He was admitted with the chief complaint of abdominal pain and subsequently developed fever and intraperitoneal free air, for which an emergency operation was carried out. A large volume of cloudy ascitic fluid was noted during the operation. No overt perforation site was found, but thickening of the ileum and its adhesion to the surrounding tissue were observed over about 20 cm of its length at a site about 80 cm from the ileocecal junction. A yellow fibrinous exudate was present over this lesion, indicating inflammtion. After intraperitoneal irrigation and drainage, part of the ileum was excised. The resected specimen showed many longitudinal ulcers, and Crohn's disease of the intestine was diagnosed histopathologically. Crohn's disease is infrequently seen in patients over 60 years old, and this case appears to be rare as the disease was accompanied by perforation. It is generally reported that elderly patients with Crohn's disease occurring only in the small intestine have a low risk of recurrence. The postoperative follow-up of this patient has continued for 2 years, and so far he has shown no signs of relapse.

Key words
Crohn's disease in the elderly patient, spontaneous free perforation of the ileum

Reprint requests
Yuji Tanaka Department of Surgery, Tenryu Byoin National Sanatorium
4201-2 Oro, Hamakita, 434 JAPAN

Accepted
January 8, 1992

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