<症例>シメチジンが奏効した膵全摘後の穿孔性胃潰瘍について

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Pancreatectomy followed by ulcer and bleeding in the area of anastmosis is seen in 11 to 50% of the patients reported. Treatment of this postoperative complication is important and the countermeasures include subtotal gastrectomy in association with pancreatectomy. By the subtotal gastrectomy the authors succeeded in curing the ulcer with cimetidine, a histamine H_2-receptor antagonist. The patient was a 52 year-old man, whose chief complaint was pain in the right hypochondrium and jaundice. Laboratory findings at the time of admission were total bilirubin 13.2 mg/dl, GOT 118 U/L, GPT 331 U/L and alkaline phosphatase 561 U/L. The diagnosis of cancer of the head of the pancreas was established by ERCP, PTCD, CT and abdominal angiography, and surgical operation was performed on December 10,1980. Laparotomy revealed a man's fist-sized tumor of the head of the pancreas. As the tail of the pancreas was also hard suggesting cancerous infiltration, the authors decided on total pancreatectomy plus subtotal gastrectomy. Although the patient was given about 50 units of regular insulin after operation the glucose levels showed unsteady fluctuations. Bile was introduced from PTC-D but the secretion of bile began to fall two days after operation, while 700 ml of gastric juice and bile mingled with blood was drained from under the left diaphragm. Gastric fluoroscopy with gastrografin revealed a niche in the fundus of the stomach with an obvious perforation. The patient was given 200 mg of Cimetidine q.i.d. for 3 days. The discharge through the drain was reduced from 830 ml to 10 ml. Interruption of the medicine was followed by an increase of the discharge to 400 ml. Therefore administration of Cimetidine was continued, and the discharge fell to zero in 24 days ; the drain was removed, and the wound healed. In short, Cimetidine was remarkably effective in treating an acute perforated ulcer of the residual stomach, probably induced by the stress after total pancreatectomy.
近畿大学の論文
1982-03-25

<症例>シメチジンが奏効した膵全摘後の穿孔性胃潰瘍について

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