Abstract
The following was our clinical experience with a patient with spontaneous rupture of the stomach probably induced by overdistention of the stomach resulting from a large pool of blood during treatment of a hemorrhagic gastric ulcer. A 72-year-old woman was admitted to our facility because of hematemesis. An endoscopic examination of the stomach revealed a large quantity of blood in the stomach. The source of the hemorrhage, however, could not be identified. About 48 hr after admission, the patient had severe hematemesis again, resulting in shock At laparotomy, 3.2 liters of blood was removed from the abdominal cavity and about 15-cm longitudinal tear was observed at the lesser curvature of the stomach. An ulcer on the posterior wall of the corpus of the stomach adhered to the spleen and the tail of the pancreas. Therefore, total gastrectomy combined with splenectomy and resection of the tail of the pancreas was performed. Histological examination revealed a 4.5×2-cm Ul-IV ulcer on the posterior wall of the corpus of the stomach, with rupture of an artery at thesite of the ulcer. It was presunled thatin the stomach inflated with blood, hematemesis causedthe intragasthc pressure to increase drastically, causing the lesser curvature to rupture. This case is the third documented adult case of spontaneous rupture of the stomach in Japan.
