Perforated viscus as first presentation of Crohn's disease: a case report

Abstract

Bowel perforation as the first presentation of inflammatory bowel disease is rare and unusual in young patients. A previously asymptomatic 21-year-old Asian male presented with perforated small bowel secondary to previously undiagnosed Crohn's disease. He underwent an exploratory laparotomy and subsequent small bowel resection and was commenced on mesalazine post-operation. He recovered well with subsequent regular follow-up with gastroenterology. The main management of Crohn's disease is multidisciplinary in nature, and collaboration between different disciplines is inherent with the aim of reducing symptoms and maximizing patient quality of life.

Figure 1

(A) Coronal slice of computed tomography (CT) image of small bowel perforation at distal ileum. (B) Sagittal slice of CT image of small bowel perforation at distal ileum.

Figure 2

Uncut specimen of small bowel showing fat creeping.

Figure 3

Cut specimen of small bowel showing 2 cm defect into the mesentery and another more proximal with 1 cm defect at the anti-mesentery border 3 cm away from the above 30 cm from IC valve.