Free intestinal perforation in children with Crohn's disease

•Free intestinal perforation (FP) is a rare but serious complication of Crohn's disease (CD).•It may occur as a first presentation of disease or at any point during the course of the disease.•Symptoms of FP are varible and may be nonspecific particularly in patients on steroids.•High index of suspicion and low threshold for appropriate imaging play a significant role in timely diagnosis.•Primary suture closure of the perforation is discouraged. Proximal diversion vs. primary anastomosis should be determined on a case-by-case basis.