A Case of Multiple Perforative Simple Ulcers of the Small Intestine

Toshihiko Waku and Wataru Osawa

Department of Surgery, Ohara National Health Insurance Hospital

Simple ulcer of the small intestine is rare, and although it is being increasingly reported, it has not been established as an independent disease entity. We report a case of simple ulcer of the small intestine with gastric ulcer that caused multiple perforation of the small intestine. A-49-year-old man was admitted to our hospital because of recurrent vomiting. Computed tomography showed ileus with thickening of the wall of the ileum and dilatation of the entire small intestine. Endoscopy was performed because of tarry stools, and it showed a refractory gastric ulcer of ul-IV in depth. The patient experienced sudden onset of abdominal pain, and the ileus was successfully treated conservatively. A diagnosis of perforative peritonitis was made, and emergency operation was performed. At laparotomy, two punched-out perforated ulcers were observed in the terminal ileum opposite the site of attachment of the mesentery, and two punched-out perforated ulcers were seen in the jejunum near the Treitz' ligament opposite the site of attachment of the mesentery. Ileocecal resection and simple closure of the perforated ulcers were performed. Since histological examination of the sites of perforation revealed only non-specific inflammation and no signs of Behet's disease, the final diagnosis was simple ulcer of the small intestine.

Key words
simple ulcer of the small intestine, multiple perforation, gastric ulcer

Reprint requests
Toshihiko Waku Department of Surgery, Ohara National Health Insurance Hospital 39-2 Nakamachi, Ohara-cho, Aida-gun, Okayama, 707-0413 JAPAN

Accepted
October 31, 2000

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