Abstract
A 55-year-old woman was admitted to the hospital because of abdominal pain. On the next day abdominal X-ray film showed free air, therefore emergency exploratory abdominal laparotomy was performed under a probable diagnosis of perforation of the digestive organ. At laparotomy, a large amount of purulent fluid and pus was found, the ileum was edematous, and perforation was found in the mesentery side 200 cm from the terminal ileum. A resection about 130 cm of ileum including the perforated region was, therefore, performed with end-to-end anastomosis. The resected specimen revealed Crohns disease of the small bowel microscopically and macroscopically. Postoperative double contrast study of the small bowel revealed a remnant lesion in the terminal ileum, but the patient had no particular symptoms. The patient is strictly followed up.
Stenosis, fistula, and abscess in the course of Crohns disease are common, but perforation of the small bowel occurs rarely. About 60 cases could be seen in the literature.
