Ileal free perforation in Crohn's disease - Including review of 60 cases reported in Japan.:Including Review of 60 Cases Reported in Japan

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A case of Crohn's disease of small intestinal type associated with ileal perforation was reported. A 39-year-old female had an episode of abdominal pain and distension accompanied by high fever several times a year since 1980. In laboratory finding on dock examination in September, 1987, anemia (Hb 9.5 g/dl), augumented erythrocyte sedimentation rate (36 mm/h) and hypoproteinemia (5.3 g/dl) were detected. In December, she developed abdominal pain and tarry stool and was diagnosed as gastric ulcer. In January, 1988, she developed severe abdominal pain suddenly. Physical examination revealed abdominal muscular rigidity and positive Blumberg's sign, and chest X-ray film demonstrated free air under right diaphragm. Under tentative diagnosis of diffuse peritonitis due to perforation of gastric ulcer, emergency operation was performed. Peritonitis caused by perforation of ileum due to Crohn's disease was confirmed. Each 10 cm of ileum proximal and distal to the perforated area was resected. In addition to the case report, 60 cases of Crohn's disease with perforation reported in Japan were briefly reviewed. Diagnosis of Crohn's disease was made after perforation in 70 % of the reported cases. About half of these cases had an episode of abdominal pain, diarrhea and high fever which may suggest Crohn's disease. Therefore, it was suggested that perforation may be avoided by adequate examination and treatment in these cases.
日本大腸肛門病学会の論文