Perforated viscus as first presentation of Crohn’s disease: a case report

Abstract

Bowel perforation as the first presentation of inflammatory bowel disease is rare and unusual in young patients. A previously asymptomatic 21-year-old Asian male presented with perforated small bowel secondary to previously undiagnosed Crohn’s disease. He underwent an exploratory laparotomy and subsequent small bowel resection and was commenced on mesalazine post-operation. He recovered well with subsequent regular follow-up with gastroenterology. The main management of Crohn’s disease is multidisciplinary in nature, and collaboration between different disciplines is inherent with the aim of reducing symptoms and maximizing patient quality of life.

Perforated ileum as the initial presentation of Crohn's disease, a case report

“…In this case, it is quite notable that the patient reported no symptoms until her first presentation to the hospital with a perforated bowel. Free perforation of the bowel as the first presentation of Crohn's disease is rare with an incidence of 3.4 %, with 86.1 % of perforations involving the ileum [4] .…”

“…Features of Trans-mural inflammation like stricture, fistula, perforation, hemorrhage, abscess, perianal disease are rare manifestations of Crohn's disease but would necessitate surgery as their mainstay of management. In 1–16 % of patients undergoing surgery for Crohn's disease, bowel perforation was the main indication [4] .…”

“…The main aspect of surgical management is to limit the amount of bowel resected as much as possible to avoid complications like short bowel syndrome [4] . Patients who are hemodynamically unstable or who have edematous bowels, significant intrabdominal contamination from perforation, or other risk factors such as Malnutrition or chronic glucocorticoid use should have a diverting stoma rather than a primary anastomosis [6] .…”

“…In several studies, the endoscopic recurrence rate was as high as 80 % one year after surgery; the clinical recurrence rate was 10 to 15 % per year. Between 70 and 90 % of patients will require surgery during their lifetime, with up to 39 % requiring repeated surgery [4] . Risk factors for recurrence are smoking, genetic (NOD2/CARD15 mutation), shorter preoperative disease duration, presence of proximal gastrointestinal (duodenum and jejunum) diffuse disease, prior surgery for Crohn's disease, first presentation with fistula or perforation are some [7] , [8] .…”

“…The main management of Crohn's disease is multidisciplinary in nature. Collaboration with the aim of reducing symptoms and maximizing patient quality of life among different disciplines is inherent [4] .…”