Colonic perforation following mild abdominal trauma in a patient with Crohn's disease: a case report

Inflammatory bowel disease is not uncommonly encountered by the general surgeon. Surgeons are normally asked for input in patients who have failed medical therapy or are suffering with complications of the disease, such as fistulation, toxic megacolon or abscess formation.Perforation is unusual in Crohn's patients, with a reported incidence of 1–2% during the course of the illness [1]. It is thought this may be due to the chronic inflammatory nature of the condition with fibrosing strictures being the more usual presentation.Perforation of the colon during colonoscopy is well recognised in patients with inflammatory bowel disease, yet there is very little in the literature on colonic perforation after minimal abdominal trauma. Literature review revealed only one such case in the United States [2].A 21 year old male presented to the emergency department with severe acute abdominal pain. He had been playing football earlier and was struck in the abdomen by an opponents shoulder. At the time, the impact was considered to be trivial. Subsequently, he developed abdominal pain and was brought to hospital. He had a history of Crohn's disease and was being managed by the gastroenterologists as an out patient. A Barium enema several months previously had shown evidence of Crohn's disease in the terminal ileum and ascending colon. He had no previous surgery and was not on steroids at the time.On examination he was hypotensive and tachycardic. His abdomen displayed signs of generalised peritonitis.Blood test showed mildly raised inflammatory markers and an erect chest x-ray showed no convincing evidence of pneumoperitoneum. The patient was fluid resuscitated and given he was haemodynamically stable; a CT was performed to diagnose further prior to surgery. Clinically, a splenic injury was the working diagnosis. Computed tomography scan revealed free gas and a perforation of the ascending colon (fig 1). There was no evidence of splenic laceration or subcapsular haematoma of the