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Updated: Sep 3, 2025
Murine Ileocolic Bowel Resection with Primary Anastomosis
Published on: October 29, 2014
Perforated ileum as the initial presentation of Crohn's disease, a case report
Robel Tadesse1, Biniam Ewnte1, Kale'ab Tesfaye1
1General Surgeon, and Medical Director, Samaritan Surgical Center, Addis Ababa, Ethiopia.
Insights
Bowel perforation as an initial presentation of Crohn's disease is rare, especially in young patients. This case highlights successful emergency surgery and subsequent medical management for a 20-year-old female with a perforated ileum.
Area of Science:
- Gastroenterology
- Surgical Gastroenterology
- Inflammatory Bowel Disease
Background:
- Bowel perforation as an initial presentation of inflammatory bowel disease (IBD) is uncommon, occurring in 0.15-3% of cases.
- Perforation is particularly rare in young patients (<30 years) and most frequently involves the ileum.
Purpose of the Study:
- To report a unique case of a young female patient whose initial presentation of Crohn's disease was a perforated ileum.
- To emphasize the importance of prompt surgical intervention in managing this rare but serious complication.
Main Methods:
- A case study of a previously asymptomatic 21-year-old female presenting with symptoms of intestinal perforation.
- Diagnostic workup included physical examination, laboratory tests (WBC 24,000), and abdominal CT scan.
- Surgical management involved emergency laparotomy, resection of the perforated ileal segment, and primary anastomosis.
Main Results:
- The patient presented with acute abdominal pain, fever, and distension, with CT confirming bowel perforation.
- Laparotomy revealed a 2x2 cm perforation on the anti-mesenteric border of the terminal ileum.
- Post-operative recovery was uneventful, with biopsy confirmation of Crohn's disease and initiation of medical therapy (Prednisolone, Azathioprine).
Conclusions:
- Initial presentation of Crohn's disease with bowel perforation is a rare clinical scenario.
- Emergency laparotomy with primary resection and anastomosis can be a life-saving procedure for hemodynamically stable patients.
- Timely diagnosis and management are crucial for favorable outcomes in such cases.
Introduction:
The perforation of the bowel as the first presentation of inflammatory bowel disease is a rare occurrence reported in about 0.15-3 % of the literature and is especially unusual in young patients <30 years of age. It is a serious event with most of the perforations occurring on the ileum. This article describes a unique case of a 20-year-old female patient who presented with perforated ileum due to Crohn's disease as an initial presentation operated at a private surgical center.
Case Presentation:
We present a case of a previously asymptomatic 21-year-old female presenting with intestinal perforation secondary to Crohn's disease for the first time. The patient presented with crampy abdominal pain and frequent bilious vomiting of 3 days duration. She also had a high-grade fever and abdominal distension. WBC was 24,000 and an abdominal CT scan showed perforation of the bowel consistent with Crohn's Disease. Ruling out other etiologies perforated viscous secondary to query Crohn's Disease was entertained and laparotomy revealed 2 × 2 cm perforation on the anti-mesenteric border of the terminal ileum. The perforated segment was resected primary anastomosis was performed. Following surgery, the patient was discharged symptom-free and linked to the Gastroenterology unit after a biopsy confirmed Crohn's disease. She was started on Prednisolone and Azathioprine exactly a month after her surgery. Her 6-month follow-up is smooth.
Conclusion:
Presentation of bowel perforation as an initial feature of Crohn's Disease is a rare phenomenon. Adequate resuscitation followed by emergency laparotomy with primary resection and anastomosis could be life-saving for a hemodynamically stable patient.
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