Free perforation in Crohn's disease: a report of 33 cases and review of literature.

Thirty-three patients with free perforation in Crohn's disease are described. There are 14 males and 19 females in this series with ages ranging from 14 to 79 years. The sites of perforation were 22 of the ileum, nine colonic, one jejunal, and one gastroduodenal. Toxic megacolon coexisted in two. Reperforation occurred in three. Free perforation was the presenting sign of the disease in three. Steroid therapy coexisted in 16 patients but in five was administered for less than 10 days before perforation. Obstruction coexisted in only three patients. There were two deaths. Twenty-two patients were treated with resection and diversion, nine patients with resection and drainage, and two with plication only. No relationship between steroid therapy, duration of disease, toxic dilatation, or obstruction with perforation could be established. Resection of the perforated disease segment is necessary when possible. In contradistinction to previous literature, free perforation in Crohn's disease is not as unusual as heretofore believed.