<症例>小児十二指腸潰瘍穿孔13歳男児の1例

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A 13-year-old boy suffering from recurrent upper abdominal pain of 4 months duration was admitted on May 27,1985 because of severe abdominal pain, vomiting and a high fever. For this case, generalized peritonitis was suspected on physical examination. A plain film of the chest showed pneumoperitoneum under the bilateral diaphragms. Although most likely preoperative diagnosis was the perforated duodenal ulcer, fiberoptic examination of the gastroduodenal system was performed preoperatively on the operation table under the general anesthesia ; the first portion of the duodenum showed deformity with an active ulcer on its anterior wall. On laparotomy, a perforation of 0.3×0.3cm was noted on the anterior wall of the narrowed edematous first portion of the duodenum. The scar tissues were prominent around the perforation with adhesion of the greater omentum. Although conservative surgical procedure is the first choice of the perforated peptic ulcer in the children, the local condition of this patient necessitated the selection of usual Billroth II gastrectomy. His postoperative course was uneventful. Peptic ulcerations have been described as primary and secondary. The postoperative examinations including psychological tests, gastrointestinal hormonal assay, and so on revealed no particular abnormality, and the patient was considered to have had primary ulceration. Although signs and symptoms of gastroduodenal ulcer in adolescents may be atypical, adequate surgical intervention is necessary to avoid the acute complications such as bleeding, perforation and so on. Besides, in the emergency surgical cases, the retrospective detection of the cause of ulceration should be performed.
近畿大学の論文
1986-03-25

<症例>小児十二指腸潰瘍穿孔13歳男児の1例

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