Objective To study the clinical features and misdiagnosis causes of Crohn disease manifested as performance of acute peritonitis. Methods The clinical data of 5 cases of Crohn disease confirmed by pathology with first manifested as acute peritonitis was retrospectively analyzed. The manifestation in all the patients showed right lower quadrant pain, with expansion to the whole abdomen and complication of nausea and vomiting. The pathogenesis was 6 to 12 h. Results 5 patients were pending cause of acute peritonitis check and were given emergency operation. Before surgery, 3 cases were misdiagnosed as acute appendicitis, 1 case as acute exacerbation of chronic appendicitis and perforation, and 1 case as ileocecal tumor perforation. 4 cases received ablation in small intestine, 1 case received intestines resection and jejunum stoma surgery. All patients who were diagnosed as Crohn disease by pathology recovered successfully. 2 cases relapsed during 3 years of follow up. Conclusion The Crohn disease manifested as acute peritonitis is rare.It is particularly difficult to diagnose before surgery, and surgical pathology is useful in confirming diagnosis.%目的 探讨以肠穿孔并急性腹膜炎表现为主的Crohn病的临床特点及误诊原因.方法 对我院收治并经病理证实的5例以以肠穿孔并急性腹膜炎为首发表现的Crohn病临床资料进行回顾分析.本组均表现为突然右下腹痛,并迅速扩展至全腹,病程6～12 h.结果 5例均以"急性腹膜炎病因待查"收入院行急诊手术,术前误诊为急性阑尾炎穿孔3例,慢性阑尾炎急性发作并穿孔、回盲部肿瘤穿孔各1例.4例行小肠部分切除术,1例行肠切除加空肠造瘘术,术后病理检查确诊为Crohn病,术后恢复顺利.随访3年,2例复发,3例无异常.结论 以急性腹膜炎为表现的Crohn病临床较少见,手术前诊断尤为困难,常需病理检查才能确诊.
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