Abstract
A 66-year-old man was admitted to our hospital with mild dyspnea, abdominal distension and hematemesis. Chronic pulmonary emphysema and right emphysematous bullae has been diagnosed 3 years previously. Chest CT scan revealed mediastinal shift by the exclusion of a huge right lung cyst. Gastrointestinal perforation was diagnosed to find the free air on chest X-ray and abdominal CT scan. Upper gastrointestinal endoscopy revealed active peptic ulcers at the gastric angle and anterior wall of the duodenal bulb. An emergency operation for pan-peritonitis and the lung cyst was performed on the same day. The patient underwent an omental patch for the perforation on the anterior wall of the duodenal bulb and wash and drainage for pan-peritonitis. Thoracoscopic resection of the right lung emphysematous bullae was performed at the same time. The patient had postoperative lung edema and lobar pneumonia which were managed with a respirator. After our multidisciplinary treatment, these diseases were improved and the patient recovered.
