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, relapsing inflammatory condition that affects the gastrointestinal tract, associated with abscesses, fistulas, and perforations. Owing to impaired integrity and proximal dilatation secondary to strictures, CD patients may be predisposed to perforations after blunt abdominal trauma. Case presentation: A 29-year-old male was admitted to a tertiary hospital after a motor vehicle accident. He underwent chest drainage for pneumothorax and remained stable. Abdominal computed tomography scan revealed pneumoperitoneum and thickening of small bowel loops. He had a prior diagnosis of CD but was lost to follow-up and therapy. Exploratory laparotomy showed jejunal perforation with multiple stenoses and inflammation. Segmental enterectomy and stapling of the bowel ends were performed, followed by temporary peritoneostomy due to instability. Reoperation 48 hours later included resection of a segment of jejunum, construction of a right-sided jejunostomy, and a left-sided mucous fistula. He remained hospitalized for 30 days for nutritional support. Later, intestinal continuity was restored by enteroenteric isoperistaltic anastomosis, Heineke–Mikulicz stricturoplasties, and dilation of remaining stenoses. Postoperative recovery was uneventful, and immunobiologic therapy was initiated. Discussion: CD’s transmural inflammation predisposes to spontaneous intestinal perforation more often than in the general population, but trauma-related perforations are rare, occurring along mesenteric borders of longitudinal ulcers near stenoses. Limited resection is generally recommended, while primary anastomosis may be unsafe in contaminated fields with active disease. Conclusion: There is no consensus for CD patients sustaining abdominal trauma. This case underscores the importance of individualized surgical strategies in minimizing associated morbidity and mortality.