Crohn's Disease Diagnosed Intraoperatively During a Trauma Exploratory Laparotomy

Crohn's disease, a chronic inflammatory bowel disease, commonly presents with abdominal pain, diarrhea, and weight loss, typically leading to diagnosis through endoscopic or imaging studies. Its incidental discovery during emergent trauma surgery is rare.

We report the case of a 25-year-old male who sustained blunt abdominal trauma in a dirt-bike accident, presenting to the emergency department the same day with progressive abdominal pain. Emergent exploratory laparotomy for a suspected bowel perforation revealed characteristic "creeping fat," inflammatory adhesions, and an enterocolonic fistula, suggesting undiagnosed Crohn's disease. The presence of acute inflammation necessitated extended small bowel resection and precluded primary anastomosis. Postoperatively, the patient developed recurrent intra-abdominal abscesses, including a subhepatic collection measuring 5.7 × 2.6 × 5 cm, as well as pleural effusions, necessitating multiple drainage procedures, targeted antibiotics, and nutritional optimization. A multidisciplinary team-including trauma surgeons, gastroenterologists, infectious disease specialists, and interventional radiologists-collaborated to manage both acute injuries and the newly recognized chronic inflammatory condition. Final pathology revealed multifocal colonic mucosal ulceration with acute inflammation, ileocolic fistula formation, and colonic perforation, consistent with a penetrating (fistulizing) phenotype, ileocolonic Crohn's disease.

This case illustrates the importance of maintaining a broad diagnostic perspective during trauma surgery and highlights how an unrecognized inflammatory bowel disease can complicate postoperative recovery. Early suspicion and tailored interventions are crucial for mitigating complications such as abscess formation and sepsis. A prompt gastroenterology consult and confirmatory investigations are recommended to guide long-term management of Crohn's disease. Ultimately, this report underscores that vigilance for atypical findings in emergent settings can significantly improve patient outcomes.