A Case of Idiopathic Perforation of the Small Intestine into Both the Abdominal Cavity and the Mesentery

Abstract

We report a rare case of idiopathic perforation of the small intestine into both the abdominal cavity and the mesentery. An 80-year-old female patient visited a previous hospital complaining of lower abdominal pain and vomiting. Abdominal CT showed free air in the abdomen and she was referred to our hospital. CT showed ileus and free air in the abdomen and retroperitoneum to the mesentery. While there was tenderness over the lower abdomen, there were no signs of peritoneal irritation, so that the patient was managed conservatively, with antibiotic therapy, ileus tube insertion and watchful observation. However, although there were no changes in the CT findings or laboratory data for over 12 hours after admission, the abdominal symptoms worsened, and emergency operation was performed. Partial ileal resection, including the segment containing the perforated lesion of abdominal side, was performed. The specimen showed another perforation on the mesenteric side. Histologically, no specific lesions suggestive of other diseases were seen around the areas of perforation. Therefore, the patient was diagnosed as having idiopathic perforation at two sites of the small intestine. The postoperative course was uneventful, and she was discharged on the 15th postoperative day.