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Free Bowel Perforations With Regional Enteritis

Frank M. Midgley, MD; Norman W. Thompson, MD
Arch Surg. 1968;97(4):553-557. doi:10.1001/archsurg.1968.01340040049006.
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ONE OF the long-recognized hallmarks of regional enteritis has been the frequency with which fistulae form between involved sections of bowel and contiguous structures. It is only recently that Robinson and Craft1 and Waye and Lithgow2 have brought to light the paucity of reported cases of free perforation in patients with regional enteritis. As Crohn himself stated in 1957, "Free perforation of ileitis into the peritoneal cavity never occurs, or at least I have not seen it."3

To date there have been 31 cases of free perforation reported. Of these, 27 occurred in terminal ileum, 3 occurred in jejunum, and 1 occurred in a Meckel's diverticulum.4 Only four of the 31 patients had a history and previous findings compatible with chronic regional enteritis.1,2,5,6

The case presented herein is particularly unusual in that the patient is the first reported to have a free cecal perforation


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