A CASE OF CROHN'S DISEASE WITH THE COMPLICATION OF FREE PERFORATION OF THE ILEUM

Abstract

We encountered a case of Crohn's disease complicated with free perforation of the ileum, fecal fistula of the ileum after appendectomy and contunuity of Crohn's disease to the appendix. We report the outline of the case and discuss the characteristics of these three complications. The patient, a 25-year-old man, was admitted to the hospital with the chief complaint of abdominal pain. A provisional diagnosis of perforative peritonitis was made, and laparotomy was undertaken. As a result, perforation was found in the small intestine, 230cm distal from the ligament of Treitz. A resection about 40cm of the small intestine including the perforated region was, therefore, performed with end-to-end anastomosis. The resected specimen showed a longitudinal ulcer located along the mesenteric border, cobblestone appearance and thickening of the ileal wall. Histologically, findings of transmural inflammatory cell infiltration mostly with lymphocytic aggregations and sarcoid-like, noncaseous granuloma were obtained. Postoperative examination of the large intestine showed longitudinal ulcers, shortening and pseudodiverticular formation in the ascending and transverse colon. Thus, the patient was diagnosed as Crhon's disease. This case is presumed to have been complicated with ileal fistula developing at a relatively high incidence after appendectomy for Crohn's disease involving the appendix, scarce in Japan.