Intestinal perforation due to abdominal trauma in a patient with previously untreated Crohn's disease

Introduction: Hollow viscera injuries, especially the small bowel, are less frequent in blunt trauma (1% of admissions), however, they are associated with significant morbidity and mortality and can be difficult to diagnose due to previous untreated diseases. Crohn's disease is a chronic and inflammatory pathology which can affect any part of the digestive tract, but mainly in the small bowel and colon. These two conditions, when associated, increase the difficulty of treatment.

Objective: Describe a difficult case of a male, 29 years old, after a highway rollover, with small bowel trauma and Crohn"s disease.

Method / Results: The patient arrived in a Trauma Center, stable with all vital signs inside normality. A pneumothorax was found at the right and a drainage was performed. A FAST exam detected abdominal free fluid and a CT scan visualized a jejunal loop perforation with a pneumoperitoneum. Thus, an exploratory laparotomy with segmental enterectomy was taken and it was performed an open abdomen with vacuum peritoneostomy. In this procedure, was observed a intense friability of the loops with edema and erythema, and stenosis, characterizing an chronic inflammatory process making it impossible to create a safe anastomosis. Three days later, a vacuum peritoneostomy was closed, a terminal ileostomy was performed, a mucous fistula and a cholecystectomy were established due to ischemia at the bottom of the gallbladder. After this treatment, a restoration of intestinal continuity was performed and the patient remained hospitalized with an enteral nutrition due to a short-bowel syndrome and to treat the Crohn's Disease.

Conclusion: Early diagnosis and appropriate treatment are essential in the care of traumatized patients with an untreated underlying disease, in order to reduce the morbidity of the condition and enable a quick and effective recovery.

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