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A rare surgical complication of Crohn's diseases: free peritoneal perforation
M Veroux1, I Angriman, C Ruffolo
1Department of Surgery and Transplantation, University Hospital, Catania, Italy. veroux@mbox.unict.it
Background:
Free peritoneal perforation is a rare complication of Crohn's disease.
Methods:
We evaluated the incidence of free peritoneal perforation among 208 patients with Crohn's disease surgically treated in the period 1992-2000.
Results:
Five patients (2.4%) suffered from free peritoneal perforation. In 1 patient free peritoneal perforation was the first symptom of Crohn's disease. In 3 cases the perforation was in the small bowel and in 2 in the large bowel. All patients underwent surgery: all cases had a resection of the involved bowel and in two cases an ileostomy was performed in order to prevent severe peritonitis. We did not observed mortality or major complications.
Conclusions:
Free peritoneal perforation is rare with about 100 cases reported in literature. No correlation seems to exist with previous corticosteroid treatment. The surgical treatment is mandatory. Simple suture should be avoided. The most appropriate treatment, whenever it is feasible, is resection of the involved bowel with immediate or, in case of severe sepsis, delayed anastomosis.
Insights
Free peritoneal perforation is a rare complication of Crohn's disease. Surgical resection of the involved bowel is the recommended treatment, avoiding simple sutures, with no observed mortality in this study.
Area of Science:
- Gastroenterology
- Surgical Gastroenterology
- Inflammatory Bowel Disease
Background:
- Free peritoneal perforation is an infrequent complication of Crohn's disease.
- Crohn's disease management often involves surgical intervention.
- Perforation necessitates prompt and appropriate surgical care.
Purpose of the Study:
- To evaluate the incidence of free peritoneal perforation in surgically treated Crohn's disease patients.
- To analyze the clinical presentation and outcomes of perforation.
- To determine optimal surgical management strategies.
Main Methods:
- Retrospective analysis of 208 patients with Crohn's disease undergoing surgery between 1992 and 2000.
- Identification of patients with free peritoneal perforation.
- Review of surgical procedures and patient outcomes.
Main Results:
- Five patients (2.4%) experienced free peritoneal perforation.
- Perforations occurred in both small (3 cases) and large bowel (2 cases).
- All patients underwent bowel resection; two required ileostomy; no mortality or major complications were observed.
Conclusions:
- Free peritoneal perforation is a rare but serious complication of Crohn's disease.
- Surgical resection of the involved bowel is mandatory; simple suture repair is not recommended.
- Immediate or delayed anastomosis following resection is the preferred surgical approach, depending on sepsis severity.
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