Abstract
There are two complications of gastrolithiasis : ileus and gastric ulcer. We encountered a case of gastric ulcer perforation after surgery for small bowel obstruction by a bezoar with hepatic portal venous gas （HPVG）. A 72-year-old man was admitted to our hospital with abdominal pain. Physical examination revealed tenderness and muscle guarding. A blood examination revealed metabolic acidosis. CT showed HPVG and distended small bowel with pneumatosis. An emergency laparotomy was performed. The small intestine was obstructed by a foreign body 170cm anal to the Treitz ligament. We conducted partial resection of the lesion. The foreign body was dark brown in color and suspected to be a gastric bezoar. We also felt other foreign bodies and removed them via stomach incision. Panperitonitis occurred and reoperation was performed on postoperative day 12. A distal gastrectomy was performed because of gastric perforation. An additional bezoar was removed from the terminal ileum. When bezoar ileus is diagnosed, the possibility of gastric ulcer formation must be borne in mind, and careful examination should be performed for the presence of other bezoars and ulcer perforation during and after the operation.
