EMERGENCY SURGICAL APPROACH FOR ABDOMINAL TRAUMA IN A PATIENT WITH CROHN'S DISEASE: CASE REPORT AND LITERATURE REVIEW

Introduction Crohn's disease (CD) is a chronic, recurrent inflammatory condition that primarily affects the gastrointestinal tract and can present with multiple complications, such as abscesses, fistulas, and perforations. Abdominal blunt trauma can more easily predispose to lacerations and perforations in areas affected by the disease.

Case Presentation A 29-year-old male was brought to the emergency department of a tertiary university hospital after a high-impact automobile accident. In the initial treatment, a chest drain was performed for right-sided pneumothorax, maintaining hemodynamic stability. The patient then underwent a CT scan of the abdomen, revealing pneumoperitoneum and thickening of the small intestine loops. The patient had a prior diagnosis of Crohn's disease with loss of follow-up, along with a history of alcohol and tobacco use. An exploratory laparotomy was indicated, where a jejunal loop perforation and several areas of stenosis and inflammation distal to the perforation were identified. A segmental enterectomy was performed, and the afferent and efferent loops were buried, with a vacuum peritoneostomy created due to instability. The patient stabilized and underwent reoperation 48 hours later, with an 8 cm enterectomy, creation of a right jejunostomy 1 meter from Treitz's angle, and a mucosal fistula on the left with a 2.5 meter distal loop. He was hospitalized for 30 days post-surgery for nutrition and stabilization. He underwent surgery for intestinal transit reconstruction by the Coloproctology team, with identification of 8 areas of intestinal stenosis, Meckel's diverticulum, and inflammatory patterns with some areas of remission in the small intestine. Intestinal reconstruction was performed with a manual isoperistaltic side-to-side anastomosis, as well as Heineke-Mikulicz stenoplasties and balloon dilation for some of the stenoses. The postoperative evolution was without complications. After discharge, he continued ambulatory follow-up, remaining asymptomatic, and was reintroduced to immunobiologics for the treatment of Crohn's disease.

Conclusion This is a rare case of blunt abdominal trauma in a patient with Crohn's disease. The surgical management of traumatic intestinal injuries in these patients is controversial in literature. Thus, the management of this patient may offer a new perspective on care and attention to minimize the morbidity and mortality associated with these conditions.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
25 April 2025