Abstract
BackgroundFree perforation is the most severe and debilitating complication associated with Crohn’s disease (CD), and it usually requires emergency surgery. The aim of this study was to evaluate the incidence of free perforation among Korean patients with CD.MethodsThe CrOhn's disease cliNical NEtwork and CohorT (CONNECT) study was conducted nationwide in Korea, and patients who were diagnosed with CD between 1982 and 2008 were included in this retrospective study. We investigated the incidence of free perforation among these patients and their clinical characteristics.ResultsA total of 1346 patients were analyzed and 88 patients (6.5%) were identified with free perforation in CD. The mean age of the free perforation group was 31.8 ± 13.0 years, which was significantly higher than that of the non-perforated group (27.5 ± 12.1 years) (p = 0.004). Free perforation was the presenting sign of CD in 46 patients (52%). Of the 94 perforations that were present in 88 patients, 81 involved the ileum. Multivariate logistic regression analysis determined that free perforation was significantly associated with being aged ≥ 30 years at diagnosis (OR 2.082, p = 0.002) and bowel strictures (OR 1.982, p = 0.004). The mortality rate in the free perforation group was significantly higher (4.5%) than that in the non-perforated group (0.6%) (p < 0.001).ConclusionThe incidence of free perforation in Korean patients with CD was 6.5%. Being aged ≥ 30 years at CD diagnosis and bowel strictures were significant risk factors associated with free perforation.
Highlights
Free perforation is the most severe and debilitating complication associated with Crohn’s disease (CD), and it usually requires emergency surgery
14 patients were excluded from the study, because thorough evaluations of their clinical and surgical findings determined that their perforations did not satisfy the definition of spontaneous free perforation (8 patients had abscess ruptures, 2 patients had fistulae that mimicked perforations, 2 patients had peptic ulcer perforations, 1 patient had a perforation caused by colonoscopy, and 1 patient had a perforation that was secondary to a GI malignancy)
Among the 88 patients with free perforation, it was the presenting sign that was associated with a diagnosis of CD in 46 patients (52%), and free perforation developed after the diagnosis of CD in 42 patients (48%)
Summary
Free perforation is the most severe and debilitating complication associated with Crohn’s disease (CD), and it usually requires emergency surgery. The aim of this study was to evaluate the incidence of free perforation among Korean patients with CD. Crohn’s disease (CD) is a chronic and relapsing inflammatory bowel disease (IBD) that can affect the entire gastrointestinal (GI) tract. The early and accurate diagnosis of CD can be challenging, in patients in whom there is mild clinical activity that mimics symptoms associated with functional GI disorders [1]. Free perforation is relatively rare among the major complications of CD that include stenoses, fistulae and perforations. Free perforation is the most severe and debilitating complication, and it usually requires emergency surgery. Doh et al BMC Gastroenterology (2015) 15:31
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