Presentation
Known patient of Crohns disease presented with severe diffuse abdominal pain.
Patient Data
A thin enhancing collection containing fluid mixed with air mottling within the inferior right hemipelvis.It lies adjacent to the distal ileum and recto-simoid pouch. Moreover, the adjacent ileal segment shows mural disruption (discontinuity) denoting bowel perforation. Another similar pocket is seen at the right paramedian plane of the lower abdomen at the level of the iliac crest related to a suspected small bowel perforation.Diffuse omental fat stranding (dirty mesentry). Multiple segmental ileal loops narrowing are seen. Dilated small bowel from the proximal jejunum to the ileum showing multiple segments of diffuse wall thickening and edema (skip lesions) accompanied by wall enhancement. Associated free turbid peritoneal fluid on all peritoneal recesses as well as scattered free air vacuoles (pneumoperitoneum).
Photo from the surgical theater denotes the site of small bowel perforation in Crohns disease.
Case Discussion
Surgical intervention is not preferred in active Crohns unless complicated, such as complete intestinal obstruction, perforation and abscess formation. After intervention in this case ileal perforation was proved.
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