A CASE OF SIMPLE ULCER OF THE SMALL INTESTINE CAUSING MULTIPLE PERFORATIONS

• Published in: Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) Vol. 65; no. 6; pp. 1578 - 1582
• Main Authors: MATSUMOTO, Atsuo, YOSHIMATSU, Kazuhiko, ISHIBASHI, Keiichiro, WATANABE, Kiyo, NARITAKA, Yoshihiko, OGAWA, Kenji
• Format: Journal Article
• Language: English
• Published: Japan Surgical Association 2004
• ISSN: 1345-2843; 1882-5133
• DOI: 10.3919/jjsa.65.1578

A 71-year-old woman complaining of abdominal pain was seen at the hospital because medication under a diagnosis of acute enteritis did not provide symptomatic remission at another hospital. Chest and abdominal plain x-rays showed free air and air-fluid level formation in the small intestine. Then generalized peritonitis due to intestinal perforation was diagnosed and an emergency operation was carried out on the same day. At surgery, three perforations about 3 mm in diameter in different sites of the ileum, and dilatation and wall thickening of the ileum about 100cm proximal to the Bauhin's valve were identified. We performed an ileocecal excision removing about 100cm of the ileum including perforations. Histopathological studies revealed multiple punched out deep ulcers and non-specific acute inflammatiory findings. We diagnosed the case as simple ulcer or Behcet's disease involving the intestine, but the case did not satisfy the diagnosis criteria for Behcet's disease. Simple ulcer was finally diagnosed. Since multiple perforations of simple ulcer of the small intestine rarely occur, this case is reported together with a review of the literature.