A Rare Cause of Acute Abdomen: Coexistence of Acute Crohn’s Disease and Gastric Perforation

Abstract

Crohn's disease (CD) is an inflammatory bowel disease with the characteristics of idiopathic, granulomatous inflammation which affects any area along the gastrointestinal system from the anus to the oral cavity. We present here an unusual case of a 25-year-old male patient, who consulted us because of abdominal pain for 2 days. The computer tomography showed free fluid at the pelvis, acute appendicitis findings and mural thickening of the terminal ileum, secondary to the appendicitis, were reported, and during the examination together with the acute abdomen findings it was decided to perform surgery on the patient. During surgery free fluid extensive inside the abdomen, at the terminal ileum indigenous for the inflammatory appearance of CD and a perforation of approximately 0.5 cm at the front face of the gastric pylorus, were seen. After the perforation at the stomach was primarily sutured and the inner abdomen was irrigated with physiological saline solution, so the surgery was brought to an end. After postsurgical antibiotherapy and hydration support, the patient was discharged and improved on the seventh day after surgery. Although CD is a chronic inflammatory disease of the gastrointestinal system, it is able to imitate the inner abdominal pathologies during an acute attack (acute appendicitis, hollow organ perforation, etc.). On patients with acute abdomen findings, where the CD diagnosis is not known, a laparotomy must be performed when a differential diagnosis of the inner abdominal pathologies cannot be made radiologically. As it is in this case, even if ileitis due to CD is determined during laparatomy, all inner abdominal organs must be explored carefully, and it should be kept in mind that the other organ pathologies can occur together. In this case the aim was to analyze the association of gastric perforation and acute CD at the terminal ileum of a patient with acute abdomen, where the diagnosis of CD is not known.