It is rare that Crohn's disease causes perforation. This paper describes a case of Crohn's disease causing ileal perforation.
A 20-year-old man was admitted to the hospital because of abdominal pain. The abdomen was distended and muscle guarding and Blumberg sign were observed. Chest X-ray film revealed no free air under the diaphragm. White blood cell count was 10600, with neutrophilia. The patient was diagnosed as peritonitis and emergency operation was carried out. At laparotomy, perforation of the ileum associated diffuse peritonitis was observed. Partial ileal resection and drainage were performed. In the resected specimen cobblestone appearance and longitudinal ulcer were observed. Histologically, transmural inflammation with noncaseous granuloma was seen and Crohn's disease was confirmed. The patient was discharged on the 38th day after surgery. There has been no recurrence, as of 2 years after the operation, and the patient is followed on an ambulant basis.
Two hundred-odd cases and 56 cases of perforated Crohn's disease have been reported in the world and Japan respectively so far. A review of the literature is also presented here.