Ileal perforation as the initial presentation of Crohn's disease in a 20-year-old female: a case report

Spontaneous small bowel perforation is an uncommon initial manifestation of Crohn's disease, particularly in young adults. We report the case of a 20-year-old woman who presented with a 24-h history of progressive abdominal pain and vomiting. Clinical assessment revealed tachycardia, abdominal distension, absent bowel sounds, and diffuse peritonitis. Laboratory evaluation showed marked leukocytosis, and computed tomography imaging demonstrated features of ileal perforation. After initial resuscitation, urgent surgical exploration identified a perforated ileal segment with associated mesenteric inflammation. Limited ileal resection with primary stapled anastomosis and a protective diverting loop ileostomy were performed. The postoperative course was uneventful, and the patient was discharged on postoperative day six. Histopathology confirmed Crohn's disease. This case highlights that ileal perforation may be the first presentation of Crohn's disease and underscores the importance of early recognition and timely surgical management in acute abdomen presentations.