Haddad Anis, Ben Mahmoud Ahmed, Chaker Youssef, Zehani Alia, Ksantini Rachid, Kacem Montasser Jameleddine
Department of Surgery A, Rabta Hospital, Tunis, Tunisia; Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.
Department of Surgery A, Rabta Hospital, Tunis, Tunisia; Faculty of Medicine of Tunis, Tunis El Manar University, Tunis, Tunisia.
Int J Surg Case Rep. 2021 Mar;80:105626. doi: 10.1016/j.ijscr.2021.02.012. Epub 2021 Feb 9.
Crohn's disease is a chronic inflammatory bowel disease with complex pathophysiology and multiple complications, some of which can be fatal. We report herein the management of an unusual case of Crohn's disease revealed by two life-threatening complications.
A 59-year-old patient presented with an acute abdominal pain evolving for one day with a clinical presentation in favor of peritonitis by perforation of the last ileal loop and acute limb ischemia. At emergency laparotomy, we found a fecal peritonitis by perforation of the last ileal loop. The patient underwent an ileo-caecal resection with rifle barrel ileo-colostomy associated with embolectomy using a Fogarty catheter of the femoral artery. Pathological examination of the specimen showed an aspect consistent with an ileo-caecal Crohn's disease and blood clot embolus of the femoral artery. Postoperative course was uneventful and the patient was kept in remission with immunosuppressants.
Several complications may arise during the evolution of the disease. However, Life-threatening complication scarcely inaugurate crohn's disease like in our patient. Free perforation of the small intestine in crohn's disease occurs rarely, which makes its statistical study difficult. Risk factors for perforation are still poorly identified. Patients diagnosed with crohn's disease have a higher risk of thromboembolic complications. Indeed, there is an association between the activity of the disease and thromboembolic events. In our case, the severity of the clinical presentation as well as its inaugural character are unique.
The management of inaugural two uncommon acute conditions in Crohn's disease is challenging.
克罗恩病是一种慢性炎症性肠病，其病理生理复杂且有多种并发症，其中一些可能是致命的。我们在此报告一例因两种危及生命的并发症而确诊的罕见克罗恩病病例的治疗情况。
一名59岁患者因急性腹痛就诊，腹痛已持续一天，临床表现提示为末段回肠袢穿孔所致的腹膜炎和急性肢体缺血。在急诊剖腹手术中，我们发现末段回肠袢穿孔导致粪性腹膜炎。患者接受了回盲部切除术及步枪筒式回肠结肠造口术，并使用Fogarty导管对股动脉进行了栓子切除术。标本的病理检查显示符合回盲部克罗恩病的表现以及股动脉的血凝块栓子。术后病程顺利，患者使用免疫抑制剂维持缓解状态。
在疾病进展过程中可能出现多种并发症。然而，像我们的患者这样以危及生命的并发症首发克罗恩病的情况很少见。克罗恩病中小肠的游离穿孔很少发生,这使得其统计学研究困难。穿孔的危险因素仍未明确。诊断为克罗恩病的患者发生血栓栓塞并发症的风险较高。事实上，疾病活动与血栓栓塞事件之间存在关联。在我们的病例中，临床表现的严重程度及其首发特征都是独特的。
处理克罗恩病首发的两种罕见急性病症具有挑战性。
