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.

Rectal Tuberculosis - A Complete Review

Tuberculosis (TB) is a communicable disease caused mainly by Mycobacterium tuberculosis and its most frequent location is lung. Tuberculosis which affects the rectum is a rare extra-pulmonary sort of the disease that needs recognition because it requires specific treatment. Clinical and endoscopic presentations of intestinal TB are often almost like those of other diseases, like neoplasias and regional enteritis. Therefore, a high level of suspicion is required, as well as the performance of microbiologic studies, to confirm the diagnosis. Tuberculosis which affects the rectum is called rectal tuberculosis. Most common symptoms of rectal tuberculosis are abdominal pain, hematochezia, bowel habit change, episodes of rectal bleeding. The causative organisms of the disease include Mycobacterium tuberculosis and Bovis. Diagnosis of rectal tuberculosis is based on characteristic endoscopic appearance of lesions, histopathologic features of tuberculosis in biopsy/ resected material, and response to antitubercular therapy. It is still a great challenge even for experienced clinicians to diagnose the abdominal tuberculosis since it is an excellent mimicker that has unusual presentations. A high index of suspicion is important for reaching its diagnosis. Keywords: Rectal tuberculosis, Tuberculosis, Rectal TB.

Can Laparoscopic Ileocolic Resection be Performed with Comparable Safety to Open Surgery for Regional Enteritis: Data from National Surgical Quality Improvement Program

Laparoscopic ileocolic resection is feasible for Crohn's disease but few studies adjust for the various preoperative, intraoperative, and postoperative variables that may confound comparisons with open surgery. The aim of this study is to compare outcomes after laparoscopic (LICR) and open ileocolic resection (OICR) performed for regional enteritis using National Surgical Quality Improvement Program (NSQIP) data. Retrospective evaluation of data prospectively accrued into the NSQIP database for patients undergoing ileocolic resection for Crohn's by LICR and OICR was performed. LICR (n = 104) and OICR (n = 203) groups had similar age ( P = 0.1), body mass index ( P = 0.9), smoking history ( P = 0.6), steroid use ( P = 0.7), diabetes ( P = 0.3), serum albumin ( P = 0.07), and American Society of Anesthesiologists class ( P = 0.13). LICR group had more female patients ( P = 0.005). Complications including surgical site infections ( P = 0.5), wound dehiscence ( P = 1), pneumonia ( P = 0.1), deep vein thrombosis ( P = 0.3), pulmonary embolism ( P = 1), urinary infection ( P = 0.1), and return to the operating room ( P = 0.2) were similar. LICR had shorter length of hospital stay than OICR ( P < 0.001). In current practice, as observed with the NSQIP data, LICR, performed by experienced surgeons, is comparable in safety to OICR and is associated with a shorter hospital stay.