Clinicopathologic features of Crohn's disease with free intestinal perforation

Abstract

Background/aims: Free perforation is the most serious intestinal complication of Crohn's disease, and early diagnosis is an important determinant of survival. The aim of this study was to evaluate the clinical and histopathologic characteristics of free perforation associated with Crohn's disease.

Methodology: Twelve free perforations in 10 patients with Crohn's disease were studied. We mainly examined the clinical characteristics, methods for definitive diagnosis and histopathologic features of free intestinal perforation with Crohn's disease.

Results: Nine patients had 1 perforation, and 1 had 3 perforations occurring within a short period. Computed tomography was significantly more sensitive than plain radiography for detecting free air in the abdomen at the time of perforation. Histopathologic examination showed that free perforation occurred most frequently in the ileum, on the side attached to the mesentery. Intestinal strictures and dilatations were presented distal to 10 perforations (83%).

Conclusions: Our results suggest that computed tomography of the abdomen was useful for the definitive diagnosis of free intestinal perforation in Crohn's disease. Histopathologic findings indicated that increased intraluminal pressure due to stricture and local circulatory disturbance of the mucosa caused by intestinal dilatation were involved in the development of free perforation in patients with Crohn's disease.