A Case of Multiple Jejunal Perforations Following Panperitonitis due to Appendiceal Perforation

Takao Sumiyoshi, Masahiro Sakata, Akihiko Ohokado, Junn Wakuya*

Department of Surgery National Kakogawa Hospital
*The First Department of Pathology, Kobe University

An 11-year-old boy admitted with a preshock condition because of panperitonitis underwnt a laparotomy under the diagnosis of panperitonitis due to perforation of the appendix. Exploration revealed appendiceal perforation, abscess cavities mainly in the ileocoecal region and the Douglas' pouch. Moreover, another abscess cavity filled with a large amount of turbid bile-like fluid was encountered in the left upper abdomen. An appendectomy with drainage of the peritoneal cavity was perormed. On the first postoperative day, a large quantity of bile discharge from the drainage tube inserted in the left upper abdomen was observed. A reoperation was carried out with a diagnosis of jejunal perforation on the third postoperative day. Intraoperative examination showed two free punched out type, round perforations, 2 mm in diameter on the side of the upper jejunum. Direct oversewing for the oral perforation and wedge resection for the other were carried out. Pathological diagnosis of the resected specimen was nonspecific ulcers of the jejunum and perforation of the ulcer. Etiologically it seemed that panperitonitis owing to appendiceal perforation may have been related to ulcer formation and perforation of the jejunum according to an unusual clinical course, intraoperative findings and pathological findings. On reviweing the literature for the last 20 years, there were no similar reports on multiple jejunal perforations which was followed by panperitonitis.

Key words
perforation of the small intestine, nonspecific ulcers of the small intestine, panperitonitis due to acute appendicitis

Reprint requests
Takao Sumiyoshi Department of Surgery, National Kakogawa Hospital
1545-1 Saiojo, Kanno-cho, Kakogawa, 675 JAPAN

Accepted
April 11, 1990

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