This paper reports a case of Crohn's disease of the colon, complicated with free perforation with a review of the Japanese literature. A 23-year-old man has been followed with the diagnosis of Crohn's disease of the entire colon in another hospital. He was admitted to the hospital because of sudden onset of abdominal pain. Plain X-ray and CT scan disclosed a free air. Emergency operation was performed with a diagnosis of free perforation of G. I. tract. A free perforation was observed in the ascending colon. Right hemicolectomy with primary anastomosis was carried out. Pathological examination revealed transmural inflammation with noncaseous granulomas and the diagnosis of Crohn's disease of the colon was confirmed. During the early postoperative course, inflammatory reactions such as spike fever and elevated CRP, persisted for 4 days, which subsided with steroid administration. The patient was discharged one and half month after the surgery without any serious complication.
Free perforation of the colon is a rare complication in Crohn's disease and 16 cases have been reported so far in Japan.