2020 Volume 45 Issue 3 Pages 233-237
A 77-year-old man visited our hospital complaining of abdominal pain. There was no history of trauma. The whole abdomen was stiff, with signs of severe peritoneal irritation. Abdominal CT showed free air and ascites. He was diagnosed as having gastrointestinal perforation and emergency surgery was performed. At the time of laparotomy, contaminated ascites was found, along with a 15 mm-sized perforation in the ileum, 40 cm from the terminal ileum, on the wall contralateral to the mesentery. There were no other abnormal findings, and partial intestinal resection and intraperitoneal drainage were performed. Histopathological examination showed no abnormalities of the mucosa around the perforated site, and a diagnosis of idiopathic perforation of the small intestine was made. In addition, a muscular defect was recognized at the periphery of the perforated area. The patient was discharged on the 16th operative day without any complications. Idiopathic small bowel perforation is a relatively rare condition. A partial defect of the intestinal muscularis has been reported as the cause of idiopathic gastrointestinal perforation. In this case also, the findings suggested the possibility of intestinal perforation due to a defect of the intestinal muscle layer.
