Free perforation of the small bowel in Crohn's disease

Abstract

Three patients with an uncommon complication of Crohn's disease are presented. A free perforation of the diseased terminal ileum was found at laparotomy in all patients. Pneumoperitoneum was not seen on x-ray. They all underwent emergency surgery with a tentative diagnosis of acute appendicitis and/or generalized peritonitis. The surgical management is described.The literature was reviewed regarding free perforation of the small bowel in Crohn's disease. The clinical and radiologicai findings of this condition are described. Simple suture of the perforation should be avoided because of the high mortality (33%) and complications rates (44%) recorded in the literature with this surgical procedure. According to the limited world experience, resection of the diseased bowel is the treatment of choice in these patients.

Free perforation in Crohn's disease: review of the Japanese literature

“…The most general factor is bowel distension with increased intraluminal pressure proximal to an obstruction. [1][2][3][4] On the other hand, in some patients, perforation may occur in the absence of intestinal dilatation. Kyle et al 63 described enteritis of small blood vessels, which is consistent with the ischemic hypothesis.…”

“…[1][2][3][4] In the present study, we evaluated the incidence of free perforation in Crohn's disease in Japan (Table 5). 35,41,[65][66][67] In five of seven Japanese studies, the incidence of free perforation was significantly higher than that in the study of Greenstein et al 1 It became clear from the present examination that the incidence of free perforation in Japan is higher than that in Western countries.…”

“…From the literature review, it may be concluded that a simple suture of the perforation should be avoided because of the high postoperative mortality and complication rates. [1][2][3][4] It is suggested that, in patients with Crohn's disease with a free perforation, resection of the diseased bowel is the treatment of choice. From the literature in Japan, there were no patients that received a simple suture of the perforation.…”

“…The incidence of free perforation in Crohn's disease has been reported to be 1.0%-2.0% in Western countries. [1][2][3][4] In 1966, Yamase et al 5 reported the first case of free perforation in Crohn's disease in Japan. Since that time, there have been additional case reports in Japan, but because of the small number of cases of Crohn's disease in each hospital, reports on the incidence of perforation in Crohn's disease are very rare.…”

Laparoscopic treatment of colonic stenosis due to perforation in crohn’s disease

“…However, perforation of the intestine is rare. One to three percent of cases with Crohn’s disease are reported to have a colonic perforation 4,5 . Kinoshita and Ishikawa reported 85 cases of perforation in patients with Crohn’s disease 6…”