A Study on Four Cases of Simple Ulcer in the Small Intestine Causing Massive Bloody Stool

Takami Fukui, Naoki Yokoo, Takahiro Yoshida, Chihiro Tanaka, Tatsushi Kato, Hisaya Azuma, Takashi Shiroko, Tetsuya Yamaguchi and Kiyonao Okamoto^*

Department of Surgery and Department of Pathology^*, Takayama Red Cross Hospital

Simple ulcer in the small intestine causing massive bloody stool is rarely encountered. We experienced four cases, all of which were diagnosed by intraoperative endoscopy during emergency laparotomy. A 44-year-old woman (Case 1), a 65-year-old man (Case 2), a 54-year-old man (Case 3) and a 67-year-old woman (Case 4) were each admitted to our hospital because of massive bloody stool. However, original lesions associated with massive bleeding were not detected in the stomach, duodenum, colon and rectum. All four patients underwent emergency laparotomies. In all cases, intraoperative endoscopy revealed hemorrhagic ulcers in the small intestine, and partial resections of the small intestine were performed. Histologic examination confirmed that the lesions were simple ulcer (Ul-II∼III). The distinct diagnosis of small intestine ulcer is very difficult by means of routine gastrointestinal examinations. Therefore, laparotomy and intraoperative endoscopy are recommended in cases where original lesions associated with bloody stool and severe anemia cannot be identified.

Key words
simple ulcer of small intestine, bloody stool, intraoperative endoscopy

Reprint requests
Takami Fukui Department of Surgery, Takayama Red Cross Hospital 3-11 Tenman-cho, Takayama City, 506-8550 JAPAN

Accepted
January 27, 1999

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