title: Internal fistula leakage due to a road traffic accident: a fortuitous diagnosis of Crohn's disease.
abstract: OBJECTIVE
  Fistulae are one of the most frequent complications of Crohn's disease (CD) and occur in 30-40% of patients. Conversely, free perforation is a rare complication and is one of the indications for emergency surgery of CD because of secondary peritonitis. We report a case of a spontaneous fistula rupture secondary to a road traffic accident.
  
  
  METHODS
  Case report.
  
  
  RESULTS
  A 22 year-old man, with no personal significant medical history, was admitted in the emergency room after a road traffic accident. He underwent abdominal CT, which revealed pelvis fractures, abnormal bowel wall of the terminal ileum (wall thickening and mucosal enhancement), peritoneal effusion within the pelvis, mesenteric nodes and extra-luminal gas within an area of mesenteric inflammation: these features were suggestive of ileum perforation associated with inflammatory bowel disease, most likely CD. Laparoscopic assessment was decided and an ileocaecal resection with ileocolonic anastomosis was performed. Histological analysis revealed terminal ileitis with ulcers, non caseating granulomas and submucosal fibrosis, a transparietal fistula and a caecoappendicular inflammation, confirming CD. Post surgical outcome was uneventful and the patient was discharged at day 9.
  
  
  CONCLUSIONS
  Our patient presented this rare complication revealing CD. The involvement of the terminal ileum and fistulae were characteristics of CD. Rupture of the fistula was favored by the trauma and responsible for the peritonitis. A resection with primary anastomosis was possible. To our knowledge, it is the first case described for the rupture of an ileal fistula secondary to traumatism in a patient with CD.
authors.affiliation: Department of Radiology, Saint Antoine Hospital, Assistance Publique-Hopitaux de Paris, Pierre and Marie Curie University (Paris VI), France.
authors.forename: Mathilde
authors.initials: M
authors.lastname: Wagner
authors.forename: Jeremie H
authors.initials: JH
authors.lastname: Lefevre
authors.forename: Benoit
authors.initials: B
authors.lastname: Royer
authors.forename: Magali
authors.initials: M
authors.lastname: Svrcek
authors.forename: Clément
authors.initials: C
authors.lastname: Pradel
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Tiret
mesh_terms: D000007:Abdominal Injuries / Q000150:complications* / Q000175:diagnosis; D000063:Accidents, Traffic; D003424:Crohn Disease / Q000150:complications / Q000175:diagnosis*; D003937:Diagnosis, Differential; D005500:Follow-Up Studies; D006801:Humans; D007082:Ileum / Q000293:injuries*; D007412:Intestinal Fistula / Q000150:complications* / Q000175:diagnosis; D010535:Laparoscopy; D008297:Male; D010538:Peritonitis / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D014057:Tomography, X-Ray Computed; D055815:Young Adult