2018 Volume 38 Issue 3 Pages 537-541
A 51-year-old male patient presented to the emergency room with sudden lower abdominal pain. Although tenderness was observed over the lower abdomen, he exhibited no signs of peritoneal irritation, and abdominal CT showed a thickened and dilated small intestinal wall and a small amount of ascites in Douglas’s pouch. When a CT scan was performed again for follow-up examination of aggravated abdominal pain, 6 hours after admission to the hospital, increased ascites and intraperitoneal free gas were confirmed. The patient was diagnosed as having perforation of the digestive tract, for which emergency surgery was performed 6 hours after admission. An approximately 6-mm, clear, perforated site was confirmed in the jejunum, approx. 20 cm distal to the Treitz ligament, and partial excision of the small intestine was performed, including the perforated site. The excised specimen showed no abnormal findings, except for a punched-out perforated site. The histopathological findings showed a small intestinal wall with full-thickness rupture, but no granulation or fibrosis, and thus it was diagnosed as idiopathic small intestinal perforation. The outcome was favorable, and the patient was discharged from the hospital on postoperative day 10. Since it is not possible to observe abnormalities other than abdominal pain in the early phase of small intestinal perforation, careful follow-up observation and reexamination should be performed for unexplained abdominal pain.
