回腸の穿孔性腹膜炎にて初めて診断されたCrohn病の1例

概要

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A 23-year-old man was admitted to our hospital because of acute onset of severe lower abdominal pain. The laboratory date showed anemia, elevated WBC with left shift and elevated CRP. Abdominal radiograph and computed tomography showed edema of the ternimal ileum but no free air. Severe tenderness, rebound soreness and muscular defence were present in the abdomen. An emergency operation was performed under the diagnosis of perforative peritonitis of the gastrointestinal tract. A perforation measuring 2mm in diameter was found in the mesenteric border of the terminal ileum 30cm orally from the ileocecal junction. A 60-cm segment of the ileum, including the perforated lesion and the skip lesion was resected and end-to-end anastomosis was performed. The resected specimen showed many longitudinal ulcers and cobble stone appearance. Crohns disease was histologically diagnosed by the findings of the intestine with trasmural inflammation and non-caseous granuloma. The postoperative course was uneventful, and the patient was discharged 18 days after the surgery. Perforative peritonitis due to Crohn's disease is relatively rare but should be included in the differential diagnosis as a probable cause of acute abdomen.
山口大学医学会の論文