title: Emergency laparoscopic ileo-colic resection and primary intracorporeal anastomosis for Crohn's acute ileitis with free perforation and faecal peritonitis: first ever reported laparoscopic treatment.
abstract: BACKGROUND
  Laparoscopy for abdominal surgical emergencies is gaining increasing acceptance given the spreading of advanced laparoscopic skills among modern surgeons, as it may allow at the same time an accurate diagnosis and appropriate treatment of acute abdomen. The use of the laparoscopic approach also in case of diffuse peritonitis is now becoming accepted provided hemodynamic stability, despite the common belief in the past decades that such severe condition represented an indication for conversion to open surgery or an immediate contraindication to continue laparoscopy. Crohn's Disease (CD) is a rare cause of acute abdomen and peritonitis, only a few cases of CD acute perforations are reported in the published literature; these cases have always been approached and treated by open laparotomy.
  
  
  METHODS
  We report on a case of a faecal peritonitis due to an acute perforation caused by a terminal ileitis in an undiagnosed CD. The patient underwent diagnostic laparoscopy followed by a laparoscopic ileo-colic resection and primary intracorporeal anastomosis, with a successful postoperative outcome.
  
  
  CONCLUSIONS
  Complicated CD has to be considered within the possible causes of small bowel non-traumatic perforation. Emergency laparoscopy with resection and primary intra-corporeal anastomosis can be feasible and may be a safe and effective minimally invasive alternative to open surgery even in case of faecal peritonitis, in selected stable patients and in presence of appropriate laparoscopic colorectal surgical skills and experience. To the best of our knowledge the present experience is the first ever reported case managed with a totally laparoscopic extended ileocecal resection with intracorporeal anastomosis in case of acutely perforated CD and diffuse peritonitis.
authors.affiliation: Maggiore Hospital Regional Emergency Surgery and Trauma Center-Bologna Local Health District, Bologna, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Birindelli
authors.affiliation: Maggiore Hospital Regional Emergency Surgery and Trauma Center-Bologna Local Health District, Bologna, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Tugnoli
authors.affiliation: Maggiore Hospital Regional Emergency Surgery and Trauma Center-Bologna Local Health District, Bologna, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Beghelli
authors.affiliation: Maggiore Hospital Regional Emergency Surgery and Trauma Center-Bologna Local Health District, Bologna, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Siciliani
authors.affiliation: Maggiore Hospital Regional Emergency Surgery and Trauma Center-Bologna Local Health District, Bologna, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Biscardi
authors.affiliation: Maggiore Hospital Pathology Department-Bologna Local Health District, Bologna, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Bertarelli
authors.affiliation: Maggiore Hospital Regional Emergency Surgery and Trauma Center-Bologna Local Health District, Bologna, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Selleri
authors.affiliation: Maggiore Hospital Regional Emergency Surgery and Trauma Center-Bologna Local Health District, Bologna, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Lombardi
authors.affiliation: Maggiore Hospital Regional Emergency Surgery and Trauma Center-Bologna Local Health District, Bologna, Italy.
authors.forename: S
authors.identifier: 0000-0001-5685-5022
authors.initials: S
authors.lastname: Di Saverio
keywords: Colorectal surgery; Crohn’s disease; Emergency Laparoscopy; Faecal peritonitis; Intracorporeal anastomosis; Small bowel perforation