Tadesse Robel, Ewnte Biniam, Tesfaye Kale'ab
General Surgeon, and Medical Director, Samaritan Surgical Center, Addis Ababa, Ethiopia.
General Surgeon, and Medical Director, Samaritan Surgical Center, Addis Ababa, Ethiopia.
Int J Surg Case Rep. 2022 Aug;97:107305. doi: 10.1016/j.ijscr.2022.107305. Epub 2022 Jun 14.
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.
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.
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.
肠道穿孔作为炎症性肠病的首发表现较为罕见，文献报道发生率约为0.15% - 3%，在30岁以下的年轻患者中尤为少见。这是一种严重事件，多数穿孔发生在回肠。本文描述了一例独特病例，一名20岁女性患者因克罗恩病导致回肠穿孔，首次就诊于一家私立外科中心并接受手术。
我们报告一例此前无症状的21岁女性首次因克罗恩病继发肠道穿孔就诊。患者出现痉挛性腹痛和持续3天的频繁胆汁性呕吐。她还伴有高热和腹胀。白细胞计数为24,000，腹部CT扫描显示符合克罗恩病的肠道穿孔。排除其他病因后，考虑为克罗恩病继发的肠道穿孔，剖腹探查发现末端回肠系膜对侧缘有一个2×2厘米的穿孔。切除穿孔肠段并进行了一期吻合。手术后，患者无症状出院，活检确诊为克罗恩病后转至胃肠病科。术后一个月开始给予泼尼松龙和硫唑嘌呤治疗。她的6个月随访情况良好。
肠道穿孔作为克罗恩病的首发特征是一种罕见现象。对于血流动力学稳定的患者，充分复苏后紧急剖腹探查并进行一期切除和吻合可能挽救生命。
