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The inflammatory reaction in regional enteritis is characteristically transmural, with affected loops of intestine frequently becoming attached to adjacent structures. As a result, deep ulcerations and fissures commonly lead to fistula formation rather than to free perforation into the peritoneal cavity. Over the past three years, we have encountered five cases of regional enteritis with free perforation. These cases and a review of the literature are presented in an attempt to clarify the pertinent factors leading to this complication. CASE REPORTS CASE 1 (89-26-98) This 11-year-old white girl was admitted to the University of Chicago Hospital with a two-year history of lower abdominal cramps and bloody diarrhoea. Barium x-ray studies revealed regional enteritis involving the distal ileum, sigmoid colon, and rectum. While on intravenous fluids, antibiotics, and corticosteroids, she experienced recurrent episodes of partial small intestinal obstruction. With sudden worsening of her symptoms, a laparotomy was performed, revealing diffuse peritonitis (mixed Gram-negative organisms). She underwent a resection of 29 cm of terminal ileum and adjacent 5 cm of ascending colon, creating a diverting ileocolostomy. Pathological examination revealed severe regional enteritis with superficial and deep ulcerations of the entire terminal ileum. A small perforation was found in the diseased ileum, proximal to a markedly thickened distal segment and 8 cm from the ileocaecal valve. Two months after the resection, the ileocolostomy was closed. Six months later, there was radiological evidence of disease in the distal 15 cm of ileum. Over the next two years, she has continued to present evidence of disease in both the distal ileum, the sigmoid, and the rectum. Though she has remained asymptomatic, she has failed to grow. CASE 2 (79-82-58) This 23-year-old white man was seen at the University of Chicago Hospital with a two-year history of abdominal pain and diarrhoea. Barium x-ray studies revealed regional enteritis involving the terminal ileum. Treatment included a bland diet, phenobarbital, belladonna, and azulphidine. Symptoms continued and the patient subsequently was admitted to hospital on two occasions with partial small intestinal obstruction. On the second admission to hospital, attempts at intestinal decompression were unsuccessful; previously active bowel sounds disappeared and a plain film of the abdomen revealed free air under both diaphragms. Laparotomy revealed diffuse peritonitis (E. coli). Resection of 48 cm of terminal ileum and 9 cm of ascending colon was accompanied by an ileocolostomy. Though the pathological examination confirmed the diagnosis of regional enteritis with moderate constriction of the lumen, no overt perforation could be found. During the five months following resection, the patient has continued well.CASE 3 (96-70-94) This 50-year-old white woman was admitted to the University of Chicago Hospital with a one-year history of abdominal pain, diarrhoea, and weight loss increasing in severity and ac...

A study was made of the prevalence of colorectal polyps (excluding juvenile polyps, familial polyposis coli and villous adenomas) and the minimum frequency of colorectal carcinoma in Southern Iran. A total of 801 large intestines from necropsies performed on individuals 20 years or older was examined with or without magnifying lens for presence of polyps. Our prevalence rate was then compared with those reported on postmortem material from the USA, Australia, South Africa (Bantus), Colombia, and Hawaii (Japanese immigrants). Our surgical pathology files were reviewed for colorectal polyps over a 22-year period (1952-1973). Colorectal carcinomas diagnosed in the Department of Pathology were reviewed over 11 years (1963-1973) and the minimum frequency rates compared with corresponding age- and sex-specific incidence rates from Connecticut, USA. The data indicate 1) a very low prevalence rate for colorectal polyps as well as carcinoma in our region and 2) a rather striking predominance of right-sided colonic carcinoma.