X-RAY FINDINDS IN THE PEDIATRIC SURGICAL EMERDENCIES : (2) PERFORATION OF THE STOMACH

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A case of pneumatic rupture of the stomach in a nineteen-month-old boy was presented. The patient who was going to be operated upon the right inguinal hernia, suddenly developed marked abdominal distention during the induction of general anesthesia under G.O.F. with a mask. The distention was not benefited by passage of a nasogastric tube. X-ray in the supine position revealed massive pneumoperitoneum showing Miller's "foot ball" sign or "air dome" sign. The pneumoperitoneum was much more evident in the confirmatory upright film.<BR>Laparotomy was performed three and a half hours after the onset of abdominal distention. At laparotomy incision of the peritoneum released a large quantity of free air, however, no apparent perforation was found in either the stomach or the small intestine, and abdominal viscera were seemed to be intact except the small hemorrhagic and emphysematous area in the lesser omentum at the junction to the stomach near cardia. The lesser omentum was detached from the stomach and a 2.5cm. linear tear was discovered along the lesser curvature. The rent was sutured in two layers and peritoneal cavity was thoroughly irrigated with warmed sterile saline. No local antibiotics was instilled and on drainage was employed. Postoperative course of the patient was uneventful.
北関東医学会の論文