Free perforation of the small bowel in Crohn's disease

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 under‐went emergency surgery with a tentative diagnosis of acute appendiciti...

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Bibliographic Details
Published in:World journal of surgery 1982-03, Vol.6 (2), p.216-219
Main Authors: Abascal, Javier, Diaz‐Rojas, Fernando, Jorge, José, Sanchez‐Vegazo, Inmaculada, Escartin, Pedro, Abreu, Luis, Chantar, César
Format: Article
Language:English
Subjects:
Adolescent
Adult
Appendicitis
Complication Rate
Crohn Disease - complications
Diseased Bowel
Female
Humans
Ileum
Intestinal Perforation - etiology
Male
Peritonitis
Small Bowel
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Summary: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 under‐went 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 radiological 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. Résumé Trois cas de maladie de Crohn qui présentaient une complication rare sont rapportés. Chez les 3 malades3 une perforation insoupconnée de l'iléon terminal fut trouvée à l'intervention. Il n'y avait pas de pneumopéritoine et le diagnostic retenu fut celui d'appendicite aiguë ou de péritonite généralisée. Le traitement chirurgical est décrit. A l'occasion de ces 3 cas de perforation iléale une revue générale de la littérature concernant le sujet a été effectuée. Les signes cliniques et radiologiques de cette condition particulière sont décrits. Il s'avère que la suture simple de la perforation ne doit pas être pratiquée car le taux de mortalité atteint 33 pour cent et celui des complications 44 pour cent. D'après cette revue de l'expérience mondiale la résection du segment intestinal intéressé constitue la méthode thérapeutique de choix.
ISSN:0364-2313
1432-2323
DOI:10.1007/BF01654694