Acute free perforation of the small intestine in Crohn's disease.

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Free perforation is a very rare comalication of Crohn's disease. In 1935, Arnheim stated this complication and seventeen cases with this complication have reported in Japan.<BR>This study reports two cases with perforation of the small intestine due to Crohn's disease. Case 1<BR>A 34-year-old man came to the hospital complaining of severe pain in all over the abdomen with tenderness, muscle guarding, and rebound tenderness. Plain abdominal X ray examination revealed free air. Emergency surgery was performed. A perforation of the terminal ileum 50 cm from the ileocecal valve, at the mesenteric border was seen. The histopathological examination confirmed Crohn's disease with a perforation. Case 2<BR>A 42-year-old man was admitted with a 6-months history of abdominal distension. Before his admission a diagnosis of colonic tuberculosis was made in the other hospital. On the second day after admission, he suddenly felt severe right lower quadurant pain. Physical examination revealed generalized abdominal guarding and rebound tenderness. We operated immediately under the diagnosis of acute peritonitis. A perforation of the ileum 3 m from the Treitz's ligament at the mesenteric border was seen. The histopathological report confirmed Crohn's disease with a perforation.
日本大腸肛門病学会の論文