Abstract
A 66-year-old woman was seen at the hospital because of a 3-day history of epigastralgia. The abdomen was board-like and there was rebound tenderness in the entire abdomen. On blood biochemical examinations, WBC was 12,400/μL and CRP was 0.40 mg/dl, showing increased inflammatory reaction. Abdominal CT scan revealed intraperitoneal free air and ascites. Panperitonits due to upper gastrointestinal perforation was likely and emergency operation was performed on the same day. Upon laparotomy, each about 2-cm diameter perforation was demonstrated at the anterior and at the posterior wall of the duodenal bulb, respectively. Simultaneous perforation of the kissing ulcers was diagnosed. Omentoplasty was tried for the each perforation, but fixation of the omentum to the perforation at the posterior wall was difficult. So the greater omentum which had filled the perforation at the anterior wall was removed, the omentum was filled into the duodenum through the posterior wall perforation, and then this filled omentum was pulled out from the anterior wall perforation to the outside of the duodenum, followed by suture with the anterior wall. As the filled omentum entailed a risk of inducing passage disturbance, gastrojejunostomy and Braun anastomosis were added. The patient's postoperative course was uneventful and she was discharged from the hospital on the 21st postoperative day.
