Free perforation in chronic regional enteritis

Alavi, Iltifat A.; Printen, Kenneth J.; Steigmann, Frederick

doi:10.1007/bf02239362

Cited by 9 publications

(1 citation statement)

References 10 publications

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“…The clinical characteristics of patients with Crohn's disease experiencing free perforation of the small intestine vary widely. A review of individual case reports (Table 1) 1,6,[11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] and larger series demonstrates an even distribution of this complication in males and females. 2,3 Furthermore, cases of free perforation have been documented in a broad range of ages as young as 11-24 years and as old as 66 years.…”

Section: Discussionmentioning

confidence: 99%

Small Intestinal Perforation Secondary to Necrotizing Enteritis—An Under-Recognized Complication of Crohn’s Disease

Huerta

Ribieras

Kodia

et al. 2022

The American Surgeon™

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Small bowel perforation is an uncommon but severe event in the natural history of Crohn’s disease with fewer than 100 cases reported. We review Crohn’s disease cases with necrotizing enteritis and share a case of a 26-year-old female who presented with a recurrent episode of small intestinal perforation. A PubMed literature review of case reports and series was conducted using keywords and combinations of “Crohn’s disease,” “small intestine perforation,” “small bowel perforation,” “free perforation,” “regional enteritis,” and “necrotizing enteritis.” Data extracted included demographic data, pre- or postoperative steroid administration, medical or surgical management, and case fatality. Nineteen reports from 1935 to 2021 qualified for inclusion. There were 43 patients: 20 males and 23 females with a mean age of 36 ± 15 years old. 75 total perforations were described: 56 ileal (74.6%), 15 jejunal (20.0%), 2 cecal (2.7%), and 1 small intestine non-specified (2.7%). 38 of 43 patients were managed surgically by primary repair (11), ostomy creation (21), or an anastomosis (11). Of 11 case fatalities, medical management alone was associated with higher mortality (5/5; 100% mortality) compared to those treated surgically (6/38; 15.8% mortality; P < .001). Patient sex, disease history, acute abdomen, and pre- or postoperative steroid use did not significantly correlate with mortality. Jejunal perforation was significantly ( P = .028) associated with event mortality while ileal was not ( P = .45). Although uncommon, necrotizing enteritis should be considered in Crohn’s patients who present with small intestinal perforation. These cases often require urgent surgical intervention and may progress to fulminant sepsis and fatality if not adequately treated.

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