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World J Gastroenterol. Aug 7, 2014; 20(29): 9990-9997
Published online Aug 7, 2014. doi: 10.3748/wjg.v20.i29.9990
Spontaneous free perforation of the small intestine in adults
Hugh James Freeman
Hugh James Freeman, Department of Medicine, University of British Columbia, Vancouver V6T 1W5, Canada
Author contributions: Freeman HJ contributed to this paper.
Correspondence to: Hugh James Freeman, MD, CM, FRCPC, FACP, Professor, Department of Medicine, University of British Columbia, 2211 Wesbrook Mall, Vancouver V6T 1W5, Canada.
Telephone: +1-604-8227216 Fax: +1-604-8227236
Received: January 20, 2014
Revised: March 21, 2014
Accepted: April 8, 2014
Published online: August 7, 2014
Core Tip

Core tip: Clinical presentation with “an acute abdomen” due to spontaneous “free” perforation usually requires urgent surgical intervention for survival. Often, the clinician is aware of an underlying disorder, but in others, this emergent situation may represent the initial clinical presentation of unrecognized Crohn’s disease or, even celiac disease already complicated by a superimposed lymphoma. Other rare causes include medical treatments for a variety of immune-mediated, inflammatory and neoplastic disorders, including some novel biological agents. Evidence also suggests that intestinal perforation could also reflect an occult genetically-based defect causing impaired connective tissue structure, synthesis and repair.