title: Clinicopathologic features of Crohn's disease with free intestinal perforation.
abstract: OBJECTIVE
  Free perforation is the most serious intestinal complication of Crohn's disease, and early diagnosis is an important determinant of survival. The aim of this study was to evaluate the clinical and histopathologic characteristics of free perforation associated with Crohn's disease.
  
  
  METHODS
  Twelve free perforations in 10 patients with Crohn's disease were studied. We mainly examined the clinical characteristics, methods for definitive diagnosis and histopathologic features of free intestinal perforation with Crohn's disease.
  
  
  RESULTS
  Nine patients had 1 perforation, and 1 had 3 perforations occurring within a short period. Computed tomography was significantly more sensitive than plain radiography for detecting free air in the abdomen at the time of perforation. Histopathologic examination showed that free perforation occurred most frequently in the ileum, on the side attached to the mesentery. Intestinal strictures and dilatations were presented distal to 10 perforations (83%).
  
  
  CONCLUSIONS
  Our results suggest that computed tomography of the abdomen was useful for the definitive diagnosis of free intestinal perforation in Crohn's disease. Histopathologic findings indicated that increased intraluminal pressure due to stricture and local circulatory disturbance of the mucosa caused by intestinal dilatation were involved in the development of free perforation in patients with Crohn's disease.
authors.affiliation: Department of Gastroenterology, Kitasato University East Hospital, Kanagawa, Japan. dm04035x@st.kitasato-u.ac.jp
authors.forename: Youichiro
authors.initials: Y
authors.lastname: Hattori
authors.forename: Kiyonori
authors.initials: K
authors.lastname: Kobayashi
authors.forename: Tomoe
authors.initials: T
authors.lastname: Katsumata
authors.forename: Katsunori
authors.initials: K
authors.lastname: Saigenji
authors.forename: Masahiko
authors.initials: M
authors.lastname: Watanabe
authors.forename: Isao
authors.initials: I
authors.lastname: Okayasu
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D003251:Constriction, Pathologic; D003424:Crohn Disease / Q000150:complications* / Q000473:pathology*; D004108:Dilatation, Pathologic; D005260:Female; D006801:Humans; D007077:Ileal Diseases / Q000000981:diagnostic imaging / Q000209:etiology; D007413:Intestinal Mucosa / Q000473:pathology; D007416:Intestinal Perforation / Q000000981:diagnostic imaging / Q000209:etiology*; D008297:Male; D011312:Pressure; D011859:Radiography