A Case of Perforated Ulcers of the Duodenum and Jejunum due to IgA Vasculitis

Abstract

A 57-year-old woman with a 1-week history of abdominal pain was admitted to the Department of Internal Medicine at our hospital. Upper gastrointestinal endoscopy showed multiple ring-shaped ulcers in the second and third portion of the duodenum. The biopsy showed vasculitis. Coagulation factor XIII was also decreased. These findings suggested ulcers due to IgA vasculitis, and corticosteroid treatment was started. On admission day 12, abdominal pain increased, and computed tomography showed free air and fluid collection in the abdominal cavity, and the wall of the distal duodenum and proximal jejunum was markedly thickened. Emergency surgery was performed for perforation of the duodenal ulcer with associated peritonitis. There were perforated sites in the fourth portion of the duodenum and the proximal jejunum. In addition to simple closure for the perforated sites, a retrograde duodenal drainage tube and an antegrade jejunal tube were inserted. Anastomotic leakage was not observed postoperatively. On the 68th postoperative day, duodenojejunal anastomosis was performed for the stenosis of the perforated site in the proximal jejunum. The patient was discharged on the 119th postoperative day.