Small Intestinal Perforation Secondary to Necrotizing Enteritis—An Under-Recognized Complication of Crohn’s Disease

Small bowel perforation is an uncommon but severe event in the natural history of Crohn’s disease with fewer than 100 cases reported. We review Crohn’s disease cases with necrotizing enteritis and share a case of a 26-year-old female who presented with a recurrent episode of small intestinal perforation. A PubMed literature review of case reports and series was conducted using keywords and combinations of “Crohn’s disease,” “small intestine perforation,” “small bowel perforation,” “free perforation,” “regional enteritis,” and “necrotizing enteritis.” Data extracted included demographic data, pre- or postoperative steroid administration, medical or surgical management, and case fatality. Nineteen reports from 1935 to 2021 qualified for inclusion. There were 43 patients: 20 males and 23 females with a mean age of 36 ± 15 years old. 75 total perforations were described: 56 ileal (74.6%), 15 jejunal (20.0%), 2 cecal (2.7%), and 1 small intestine non-specified (2.7%). 38 of 43 patients were managed surgically by primary repair (11), ostomy creation (21), or an anastomosis (11). Of 11 case fatalities, medical management alone was associated with higher mortality (5/5; 100% mortality) compared to those treated surgically (6/38; 15.8% mortality; P < .001). Patient sex, disease history, acute abdomen, and pre- or postoperative steroid use did not significantly correlate with mortality. Jejunal perforation was significantly ( P = .028) associated with event mortality while ileal was not ( P = .45). Although uncommon, necrotizing enteritis should be considered in Crohn’s patients who present with small intestinal perforation. These cases often require urgent surgical intervention and may progress to fulminant sepsis and fatality if not adequately treated.

Case Report: Pediatric Malignant Atrophic Papulosis With Small Bowel Perforation and Positivity of Anticardiolipin Antibody

Malignant atrophic papulosis (MAP) is a life-threatening vasculopathy affecting the skin, gastrointestinal tract, central nervous system, pleural membrane, and pericardium. MAP carries a poor prognosis primarily because of its systemic involvement. It is extremely rare in children. Herein, we report a pediatric case of MAP with small bowel perforation and anticardiolipin antibody positivity.

Small bowel perforation with iliac artery prosthesis stump

Aim: In this case we report an unusual complication after retroperitoneal formation of an iliac artery prosthesis-stump – a bowel perforation and sepsis. Case report: During the open urology surgery a right external iliac artery was iatrogenic injured and iliofemoral bypass grafting was performed. Eight months thereafter, due to an inguinal site graft infection and graft occlusion, the distal part of the prosthesis was transacted and removed, and the proximal, retroperitoneal part, was closed and over sewn in the zone without any sign of infection present. This prosthesis-stump caused a very unusual complication – a small bowel perforation three months thereafter. Conclusion: The whole retroperitoneal graft should always be removed with no stump formation to avoid this complication.

Spectrum of presentation and prognostic factors in non-traumatic small bowel perforations

Background: The small bowel perforation peritonitis is one of the main causes of generalized acute peritonitis in developing countries.The aim is to find out the prognostic factors affecting the mortality and morbidity of non-traumatic small bowel perforations.Methods: A total of 50 patients of any age and either gender of non-traumatic small bowel perforation peritonitis were included and studied prospectively. The prognostic evaluation was assessed by the impact of pre-operative prognostic factors and per operative findings on post-operative complications and mortality.Results: One third of the patients were of 20-30 years of age followed by 18% who belonged to 10-20 years age group. Operative findings revealed mean duration of surgery was 2 hours. Majority of patients (33) had bilio-purulent peritonitis. Post-operative pulmonary complication revealed 56% (28 out of 50) patients were having pulmonary complications. Post-operative wound complication showed surgical site infection as the most common complication noted and managed by sending wound culture and changing antibiotics. Second most common was burst abdomen managed initially by dressing and thereafter secondary wound closure. Delay in intervention (DII) had significant correlation with world society of emergency surgery (WSES) score and amount of peritoneal fluid.Conclusions: Most common cause of non-traumatic small bowel perforation was typhoid ileal perforation with most common presentation being pain abdomen. The significant factors defining the outcome of these patients were volume of intra-peritoneal fluid (purulent/fecal) >1000 ml, WSES score >6 and Mannheim’s peritonitis index (MPI)>18.

Small Bowel Perforation Due to Blunt Trauma of Left Leg With an Incarcerated Inguinal Hernia: A Case Report

We report a rare case of a 77-year-old man with a known left inguinal hernia presenting with groin pain following a blunt trauma of the left leg. Diagnosis of small bowel perforation away from the hernia was obtained only in surgery. Difficulty in preoperative diagnosis, rarity of histologic pattern, and surgical challenges make this case very interesting for surgeons and radiologists. Our conclusion upon dealing with the situation is that the diagnosis of small bowel perforation following blunt injury to a non-abdominal trauma is rare and difficult. The association between inguinal hernia and non-abdominal trauma may result in small bowel injuries that normally do not appear. Therefore, clinicians should be cautious in treating non-abdominal trauma patients with inguinal hernias.

Small bowel perforation secondary to foreign body ingestion mimicking appendicitis: a case report

Admittance in the emergency room with complaints of acute abdominal pain is a common scenario. Patients who see the doctor due to foreign object ingestion present transitory symptomatology. In most cases, foreign object ingestion in adults is accidental, although it may be linked to physiological, anatomical, mechanical, social and psychiatric factors. The frequency of voluntarily ingested objects is higher among children and teenagers than in any other age group. Few people go to the doctor because of persistent clinical manifestations or secondary manifestations of previous complications. In most cases, the foreign body is found incidental to another medical procedure. Here we report a case of small bowel perforation due to ingestion of a sharp foreign body in a 2 years old child. We further elaborate that how, in paediatric age group these conditions are frequently misdiagnosed and usually present late to us. Hence, the increasing need and importance of a thorough pre-op workup, especially in the pediatric age group.