A Case of Free Perforation of the Ileum in Crohn's Disease.

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  • 回腸穿孔による汎発性腹膜炎にて発症したＣｒｏｈｎ病の１例

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Abstract

A 23-year-old man was admitted to the hospital because of the sudden onset of severe pain in the right middle-lower quadrant of the abdomen. There were tenderness, muscle guarding, and rebound tenderness. Emergency surgery was performed with a diagnosis of acute appendicitis with peritonitis. At laparotomy, there was adherent and stenosing terminal ileum, and was a free perforation at the mesenteric border in the proximal dilatated bowel. The appendix looked almost normal. Primary resection of the cecum and terminal 100cm of the ileum, including the perforated bowel, was performed with an end to end anastomosis. The resected specimen showed longitudinal ulcer and fistula formation at the terminal ileum. The perforation was seen in the longitudinal ulcer at the site about 50cm from the ileocecal junction. Histologically, lymphoid aggregation and non-caseating granulomas containing giant cells were noted in the submucosa and deeper layers. It is etiologically suggested that increasing intraluminal pressure and progressive ulceration in the diseased bowel proximal to a stenosing lesion facilitated the occurrence of free perforation. Crohn's disease should be included in the differential diagnoses of perforated peritonitis.

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