Abstract
Simple ulcer of the small intestine is rare, and although it is being increasingly reported, it has not been established as an independent disease entity. We report a case of simple ulcer of the small intestine with gas-tric ulcer that caused multiple perforation of the small intestine. A-49-year-old man was admitted to our hospital because of recurrent vomiting. Computed tomography showed ileus with thickening of the wall of the il-eum and dilatation of the entire small intestine. Endoscopy was performed because of tarry stools, and it showed a refractory gastric ulcer of ul-IV in depth. The patient experienced sudden onset of abdominal pain, and the ileus was successfully treated conservatively. A diagnosis of perforative peritonitis was made, and emergency operation was performed. At laparotomy, two punched-out perforated ulcers were observed in the terminal ileum opposite the site of attachment of the mesentery, and two punched-out perforated ulcers were seen in the jejunum near the Treitz'ligament opposite the site of attachment of the mesentery. Ileoce-cal resection and simple closure of the perforated ulcers were performed. Since histological examination of the sites of perforation revealed only non-specific inflammation and no signs of Behcet's disease, the final diagno- sis was simple ulcer of the small intestine.
