Free perforation in Crohn's disease: review of the Japanese literature

Background:

Reports of free perforation in Crohn's disease have been increasing in Japan. In this study, we investigated the characteristics of free perforation in Japanese patients with Crohn's disease. Methods: We reviewed the data for 104 patients with free perforation in Crohn's disease reported in the Japanese literature, in addition to 22 patients from our hospital. Results: There were 89 men and 37 women in this series, with ages ranging from 16 to 92 years. Free perforation was the presenting sign of the disease in 72 patients. The perforation sites were the jejunum in 7, the ileum in 102, and the colon in 17. Multiple perforations occurred in 13 patients. Steroid therapy was administered in 25 patients, but the relation between steroid therapy and free perforation had not been well established. The incidence of free perforation in Crohn's disease in Japan was between 2.9% and 10.5%. This incidence was higher than that in Western countries. Ninety-eight patients were treated with resection and drainage, and 22 patients with resection and diversion (details were not known in 6 patients). There were no patients with simple closure of the perforation site. Anastomotic rupture occurred in 13 patients. Five patients died after the operation. Four of these five patients had multiple perforations. Conclusions: The incidence of free perforation in Japan is higher than that in Western countries and patients with multiple perforations have a poor prognosis.