[A case of perforation of the small intestine in Crohn's disease].

Perforation of the small intestine occurs rarely in the course of Crohn's disease. A case of perforation of the ileum affected by Crohn's disease was presented. A 92-year-old woman was admitted to the hospital complaining of sudden onset of abdominal pain. Laparotomy revealed peritonitis and two perforations in the diseased ileum. She underwent resection of 60 cm of terminal ileum, ileocecum and adjacent 5 cm of ascending colon with an end-to-end ileocolic anastomosis. The intestinal wall of 40 cm of terminal ileum was thickened and edematous. The bowel lumen was narrow. Several longitudinal ulcers were seen. Histological examination of the resected specimen revealed the perforation in Crohn's disease. The intestinal wall was thickened. The mucosal surface was ulcerated and focally perforated. Ulcerated base was covered by abundant necrotizing mass. The submucosa was replaced by non-caseous inflammatory granuloma comprising with fibroblasts, lymphocytes and plasma cells. Perforated area showed abscess formation with plentiful granulocytes. She died of pneumonia 10 days after operation.