Free peritoneal perforation in a patient with Crohn's disease – Report of a case

Leal, Raquel Franco; Ward, Marc A.; Ayrizono, Maria de Lourdes Setsuko; Paiva, Nielce Maria de; Bellaguarda, Emanuelle; Rossi, Debora Helena; Vieira, Natália Pranzetti; Fagundes, João José; Coy, Cláudio Saddy Rodrigues

doi:10.1016/j.ijscr.2012.12.018

Cited by 7 publications

(4 citation statements)

References 17 publications

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“…Free perforation is the initial symptom of CD in 1%-3%[13] up to 30%[14]. Free perforation is the indication for surgery in 1%-16% of surgical intervention in CD[15].…”

Section: Indications For Major Gastrointestinal Surgery In CDmentioning

confidence: 99%

Indications and surgical options for small bowel, large bowel and perianal Crohn's disease

Toh¹,

Stewart²,

Rickard³

et al. 2016

WJG

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Despite advancements in medical therapy of Crohn’s disease (CD), majority of patients with CD will eventually require surgical intervention, with at least a third of patients requiring multiple surgeries. It is important to understand the role and timing of surgery, with the goals of therapy to reduce the need for surgery without increasing the odds of emergency surgery and its associated morbidity, as well as to limit surgical recurrence and avoid intestinal failure. The profile of CD patients requiring surgical intervention has changed over the decades with improvements in medical therapy with immunomodulators and biological agents. The most common indication for surgery is obstruction from stricturing disease, followed by abscesses and fistulae. The risk of gastrointestinal bleeding in CD is high but the likelihood of needing surgery for bleeding is low. Most major gastrointestinal bleeding episodes resolve spontaneously, albeit the risk of re-bleeding is high. The risk of colorectal cancer associated with CD is low. While current surgical guidelines recommend a total proctocolectomy for colorectal cancer associated with CD, subtotal colectomy or segmental colectomy with endoscopic surveillance may be a reasonable option. Approximately 20%-40% of CD patients will need perianal surgery during their lifetime. This review assesses the practice parameters and guidelines in the surgical management of CD, with a focus on the indications for surgery in CD (and when not to operate), and a critical evaluation of the timing and surgical options available to improve outcomes and reduce recurrence rates.

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“…Free perforation is the initial symptom of CD in 1%-3%[13] up to 30%[14]. Free perforation is the indication for surgery in 1%-16% of surgical intervention in CD[15].…”

Section: Indications For Major Gastrointestinal Surgery In CDmentioning

confidence: 99%

Indications and surgical options for small bowel, large bowel and perianal Crohn's disease

Toh¹,

Stewart²,

Rickard³

et al. 2016

WJG

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show abstract

“…The management of colonic perforation in CD varies and depends upon whether perforation is due to toxic megacolon or segmental colitis. In the case of toxic megacolon and perforation, total colectomy and end ileostomy is the treatment of choice and segmental resection is the preferred treatment in case of isolated segmental Crohn’s colitis with perforation [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

A Case Report and Literature Review of Rectosigmoid Crohn’s Disease: A Diagnostic Pitfall Ultimately Leading to Spontaneous Colonic Perforation

Ali¹,

Tariq²,

Abid³

et al. 2023

Cureus

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Inflammatory bowel disease (IBD) is a chronic condition that affects the gastrointestinal tract, with ulcerative colitis (UC) and Crohn's disease (CD) as the two major entities. While these conditions share some similarities in clinical presentation, they have distinct histopathological features. UC is a mucosal disease affecting the left colon and rectum, while CD can affect any part of the gastrointestinal tract and all layers of the bowel wall. Accurate diagnosis of UC and CD is important for effective management and prevention of complications. However, distinguishing between the two conditions based on limited biopsy specimens or atypical clinical presentations can be challenging. We present a case of a patient diagnosed with UC based on a single endoscopic biopsy from the sigmoid colon, who later presented with colonic perforation and was found to have CD on the colectomy specimen. This case emphasizes the importance of clinical guidelines when dealing with any patient of suspected IBD, considering alternative diagnoses in patients with atypical presentations and the need for careful clinical, endoscopic, and histological evaluation to make an accurate diagnosis. Delayed or missed diagnosis of CD can lead to significant morbidity and mortality.

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“…In patients with associated malignancy, some authors recommend that the opportunity of primary anastomosis and bypass protection should be judged individually, upon the patient's clinical condition and past history of steroid use. However, when malignancy and perforation are associated, anastomosis is not recommended, being associated with high morbidity and mortality (17)(18)(19)(20). Careful examination of the vascularization of anastomosis tranches is important to prevent anastomosis leaks, one of the most frequent causes of postoperative morbidity (21).…”

Section: Discussionmentioning

confidence: 99%

Small bowel adenocarcinoma arising in longstanding fibrostenotic Crohn’s disease

Dumitrescu

Dumitru

Alexandra

et al. 2021

MSJ

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Free peritoneal perforation in a patient with Crohn's disease – Report of a case

Abstract: Emergency conditions in CD may result in significant morbidity, but are normally associated with low mortality, if identified and treated properly.

Cited by 7 publications

References 17 publications

Indications and surgical options for small bowel, large bowel and perianal Crohn's disease

Indications and surgical options for small bowel, large bowel and perianal Crohn's disease

A Case Report and Literature Review of Rectosigmoid Crohn’s Disease: A Diagnostic Pitfall Ultimately Leading to Spontaneous Colonic Perforation

Small bowel adenocarcinoma arising in longstanding fibrostenotic Crohn’s disease

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